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Health Insurance Rules: Will AYUSH treatment coverage match conventional care? , Business

new health insurance rules, ayush treatment (Ayurveda, Yoga, Unani, Siddha and Homeopathy) have increased in popularity in recent years. However, some health insurance Companies in India provide coverage for these treatments. To address this, Insurance Regulatory and Development Authority of India (IRDAI) has directed insurers to update their policies and ensure that AYUSH treatment coverage Same as other treatments.
IRDAI said in a circular issued on January 31, 2024 that due to increasing demand Ayush In the case of treatments, they should be considered on an equal footing with other treatments.
ayush treatment
According to Reliance General Insurance, AYUSH includes Ayurveda, Yoga, Unani, Siddha and Homeopathy treatments, which are alternatives to conventional medicine. AYUSH has been supported by the government, with a dedicated ministry formed for its development. An ET report said that despite government efforts, both rural and urban families still prefer traditional allopathic treatment over AYUSH.
Read this also IRDAI’s draft guidelines to protect insurance policyholders: 5 key changes to know about
Integrating AYUSH with traditional treatments
IRDAI has advised all insurers to follow the following guidelines, which will be effective from April 1, 2024.

  1. Board-approved policy: To ensure that policyholders have the freedom to choose their treatment, insurers must set up a board-approved policy to provide AYUSH coverage. This policy should detail how AYUSH treatments will be treated equally with other treatments for health insurance purposes.
  2. Product Modification: Insurers should modify their current products that prohibit AYUSH treatments and ensure that they comply with the instructions.
  3. Quality Criteria: The policy should include quality standards and procedures for nominating AYUSH hospitals and day care centers as network providers for providing cashless services. Insurers should also put in place adequate controls and SOPs.
  4. Standard Operating Procedures (SOP):
  1. Insurers must establish procedures for enrolling hospitals into their networks.
  2. They should include relevant clauses in their healthcare agreements with AYUSH hospitals/day care centres.
  3. Insurers must define standard treatment protocols.
  4. They must have measures in place to deal with potential fraud and abuse of the system.

AYUSH Treatment Insurance Coverage
Health insurance covering AYUSH treatments generally includes the following:

  • Expenditures in government hospitals recognized by the National Board for Health Accreditation (NABH) or Quality Council of India (QCI).
  • Inpatient treatment expenses at NABH and QCI-accredited facilities providing Ayurveda, Yoga, Unani, Siddha and Homeopathy treatments.
  • Enrollment fees at Yoga institutes within the policyholder’s state as part of preventive wellness measures.

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