Irdai Brings Ayush Treatment Under The Ambit Of Health Insurance, Starting April 1

The Insurance Regulatory and Development Authority of India (Irdai) has instructed general insurance companies to ensure that Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) are treated equally with other medical treatments in their health insurance policies, citing their increasing popularity, according to a recent Irdai press statement. General insurance companies are required to establish board-approved policy guidelines for AYUSH coverage and offer policyholders the choice to select their preferred treatment option. These guidelines are scheduled to be implemented from April 1, 2024.

The guidelines should outline quality standards and procedures for AYUSH hospitals or daycare centres to join as network providers for cashless treatment. “In recent times, AYUSH treatments have garnered increased popularity and have become an established branch of medicine. Considering the growing demand for AYUSH treatments, there is a need to consider these treatments at par with other treatments,” says Irdai in a press statement.

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Insurance companies have also been instructed to implement adequate controls and standard operating procedures. The General Insurance Council (GIC), representing these companies, has recently initiated a program to offer cashless treatment to policyholders even in hospitals not listed in their network but registered under the Clinical Establishment Act.

Irdai has urged companies to adjust products with restrictions on AYUSH treatments to comply with the updated guidelines. Furthermore, the regulator has directed general insurers to collaborate with the Core Group of Experts for the insurance sector established by the AYUSH ministry to develop necessary arrangements for AYUSH coverage. In December, the Madras High Court directed Irdai to treat AYUSH treatments equally with allopathy in reimbursing medical expenses.

Ayush Treatment: Under AYUSH, individuals can receive coverage for alternative treatments to allopathic medicine. AYUSH is a government initiative, with the AYUSH Ministry established to oversee its development and promote these traditional medical practices. Despite significant government efforts, both rural and urban households still predominantly favour allopathic treatment. Following Irdai's directive for insurers to include AYUSH treatment in their medical coverage, there has been a surge in demand, prompting insurers to introduce competitive plans to expand their accessibility.

Any health insurance policy incorporating AYUSH treatment covers all mentioned alternative medical practices, with reimbursement also available for yoga fees as part of preventive wellness add-ons. The coverage amount for AYUSH treatment typically ranges from Rs 2500 to Rs 20,000, depending on the chosen plan. It's important to note that reimbursement for AYUSH treatment expenses is contingent upon treatment occurring at a government-approved hospital or centre. AYUSH coverage does not extend to evaluation or check-up expenses, nor does it cover treatment at non-approved healthcare facilities that are not hospitals.