Let’s Unveil The Scope of AYUSH Under Health Insurance

On a state-level, Rajasthan recruited 2,752 AYUSH doctors on contractual basis in 2016. Further, Himachal Pradesh has one of the highest percentages of people using traditional medicines. Homeopathy enjoys more popularity in eastern states—West Bengal, Bihar, Odisha and Assam.

IRDAI Regulation to include AYUSH:

The Insurance Regulatory and Development Authority of India (IRDAI) in the year 2013 recommended the health insurance companies to include AYUSH in their coverage and provide all the same benefits as provided in the case of the other treatments.

AYUSH being the government body has made it possible for the health providers to include it in the coverage. AYUSH is now being used by many Indians and even gaining popularity because of its low-cost treatments. It has restored the faith of the people in the Indian traditions once again.

Now, AYUSH is being covered by many individual as well as group mediclaim policies. Some of the plans may not include all the components of AYUSH and just provide the coverage of one or two treatments included in it. Every insurance company has a different scope of coverage for AYUSH.

Scope and limitations of AYUSH coverage:

• The plans that provide for AYUSH coverage reimburse only up to a certain percentage of the sum insured. It is restricted to the percentage of 7% to 25%, depending upon the terms and conditions of different plans. Some insurance companies have fixed a specific amount as a sub-limit for claiming benefits under AYUSH.

• Some health insurance policies are offering cashless benefits under AYUSH. Most of them require the claimant to submit necessary bills and other specific documents to claim benefits under this option.

• For claiming the benefits under AYUSH, the treatment is required to be undertaken inspecific government hospitals accredited by the Quality Council of India or National Accreditation Board of Health.

• There is a compulsory co-payment clause in most of the health insurance policies providing coverages for AYUSH. So, you need to pay part of the treatment cost under AYUSH out of your pocket.

• The benefits of AYUSH under in-patient hospitalization is only available if the claimant is hospitalised for a period more than 24 hours in the accredited hospital and most of the health insurance plan covers for in-patient treatments under it.

• The insurance companies are charging a 5% to 10% higher premium than the normal premium to provide coverages for AYUSH.

• There are very few hospitals and facilities providing non-allopathic treatments under AYUSH. So, the coverage for AYUSH by health insurance policies is very limited. The insurance companies are still hesitant to include AYUSH as a mainstream benefit.

Various insurance companies offer several benefits based on fitness level. For instance, if you join yoga classes for a minimum one year, the insurer will reward you with wellness points. These points can be later redeemed to avail benefits which are normally not covered under health insurance policies, like OPD expenses, dental procedures, consultation charges, etc.

Further, the central government is planning to roll out a national policy for AYUSH to include ayurveda, unani, siddha and homeopathy under its universal health insurance scheme.

Since most of the people firstly approach allopathic doctors for any health problem, this is why insurance companies are reluctant to provide full coverage to AYUSH. Maybe in the coming few years, you could see the same coverages and benefits for non-allopathic treatments by health insurance policies.