New Health Insurance Rule: IRDAI Brings AYUSH under Health Cover from April 1

AYUSH treatments have recently generated massive popularity as an emerging branch of medicine. Looking at the increasing demand for the treatment, it has become imperative to consider AYUSH at par with other treatments available in general.

The expansion of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) Treatment to bring them at par with other treatments will likely open new doors of opportunities in the insurance industry.

In its new guidelines, the Insurance Regulatory and Development Authority of India (IRDAI) has directed the insurance companies offering general and health insurance plans to work toward removing any limitation towards offering health insurance policies with AYUSH treatment coverage.

Let us know more about this new health insurance rule regarding AYUSH treatment in health insurance in this post!

What is AYUSH Treatment?

AYUSH is the short form of (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) therapies. Policies offering AYUSH coverage allow policyholders to avail of all the treatments that come under AYUSH, which serve as an alternative to allopathic treatment options.

Over the years, therapies and treatments under AYUSH have become increasingly popular to cure diseases. Despite that, not many health insurance companies in India cover AYUSH treatment under their policy. Looking at this scenario, the IRDAI has directed insurers to modify their existing policies to make AYUSH treatments equal to other healthcare treatments.

IRDAI’s Recommendation on AYUSH Treatments to be at Par with Other Treatments 

As per IRDAI’s recommendations, insurers must adhere to the regulator’s command to include AYUSH treatment under health insurance policies starting April 1, 2024. This allows policyholders the freedom to choose the treatment of their choice. The insurers are expected to include an AYUSH coverage policy approved by IRDAI.

Below are the key points that insurers are advised to comply with:

1. Board Approved Policy:

The insurers are expected to include an AYUSH coverage policy approved by the IRDAI. They are also required to summarize how they are going to treat AYUSH treatments at par with other modes of treatment for coverage under the health plans.

2. Remove Limitations:

Insurers are also directed to modify their existing health insurance policies to remove all limitations concerning AYUSH treatment and to comply with the directives of IRDAI.

3. Policy for Quality Parameters:

The parameters for joining AYUSH Hospitals and Day Care Centers under the health policies as network providers should be done to offer a cashless facility.

4. Standard Operating Procedures (SOP)

As per the directive of IRDAI, insurance companies will have reasonable control and SOP or Standard Operating Procedures for the following:

• Joining hospitals with the network of the insurer;
• Introducing clauses as needed in the policy agreement about AYUSH Hospitals/Day Care Centers,
• To maintain the protocol of standard treatments, and
• To Deal with fraud and system abuse of any kind

What is AYUSH Treatment Insurance?

AYUSH Treatment Insurance policies are the health insurance plans that cover AYUSH treatments and are available with their list of policy inclusions and exclusions mentioned below.

Expenses Covered (Inclusions) Under AYUSH Treatment

Under the AYUSH health insurance treatments, policyholders can raise claims for the below-mentioned expenses:

• If AYUSH health care is availed of at a government hospital accredited by the Quality Council of India (QCI) or National Accreditation Board of Health (NABH), the expenses incurred for the same would be taken care of by the insurer
• For in-patient hospitalization at an accredited AYUSH Treatment hospital or center offering AYUSH therapies, the expenses will be covered
• Similarly, costs will be taken care of by the insurer if the insured pays any yoga center enrolment fees in your state as a part of your preventive wellness