Is AYUSH treatment covered under health insurance policy?

The alternative treatment has seen a huge increase over the past few years. With the push of the government for treatments based on natural ingredients the concept has gained popularity not only in India but also abroad. Having said that, before going for such treatments you need to know whether Ayush treatment is covered under your health insurance policy. Here are the details of what all it includes and excludes:

What is Ayush?

AYUSH is the acronym for Ayurveda, Yoga, Unani, Siddha and Homeopathy which offers an alternative to allopathic treatment. For developing the concept, the Ministry of Ayush was formed on 9th November 2014 for focussed attention on alternative treatments. Earlier it was known as the Department of Indian System of Medicine and Homeopathy (ISM&H) which was created in March 1995 and renamed as Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (Ayush) in November 2003.

Is Ayush covered under a health insurance policy?

You need to read your policy terms and conditions to understand whether your policy covers the Ayush treatment. Some policies cover it others might not as per the product features offered by the insurers. However, recently, Insurance Regulatory and Development (IRDAI) mandated that Ayush treatments need to be covered from 1 April 2020 under Arogya Sanjeevani, a standard health insurance product.

Eligibility criteria

According to IRDAI definition following are the qualified centres for Ayush treatment:

a. Central or State Government Ayush Hospital; or

b. Teaching hospital attached to Ayush College recognized by the Central Government/Central Council of Indian Medicine/Central Council for Homeopathy; or

c. Ayush Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine, registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered Ayush Medical Practitioner and must comply with all the following criterion:

i. Having at least 5 in-patient beds;

ii. Having qualified Ayush Medical Practitioner in charge round the clock;

iii. Having dedicated Ayush therapy sections as required and/or has equipped operation theatre where surgical procedures are to be carried out;

iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized representative.

Also, the patient should be hospitalized for more than 24 hours in a recognized hospital.

Things not covered under Ayush treatment

1. Generally, policies cover up to 25% of the sum insured for Ayush treatment.  Arogya Sanjeevani Policy, however, covers up to the entire sum insured.
2. Not all policies offer cashless treatment for Ayush. Many settle it through the reimbursement process.
3. Treatment should be taken at a government-approved hospital or centre. It does not cover treatment if the health care facility is not approved.
4. It does not cover evaluation or check-up expenses for the policyholder.
5. Just like the regular health insurance, the claim needs a minimum hospitalisation of more than 24 hours,
6. Pre-hospitalization and Post-hospitalization expenses might not get covered
7. Preventive and rejuvenation treatments are excluded.