Health insurance rules: AYUSH Treatment coverage to match conventional care? Top things to know

TOI Business Desk / TIMESOFINDIA.COM / Mar 1, 2024, 08:12 IST

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Insurance Regulatory and Development Authority of India (IRDAI) instructs insurers to provide equal coverage for AYUSH treatments. AYUSH includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy therapies. Insurers must establish policies, modify products, and ensure quality standards for AYUSH coverage.

Health insurance rules: AYUSH Treatment coverage to match conventional care? Top things to know

New Health Insurance Rule: AYUSH therapies (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) have grown in popularity in recent years. However, few health insurance companies in India offer coverage for these treatments. To address this, the Insurance Regulatory and Development Authority of India (IRDAI) has instructed insurers to update their policies and ensure that AYUSH treatment coverage is equal to other treatments.
IRDAI stated in a circular dated January 31, 2024, that due to the increasing demand for AYUSH treatments, they should be regarded on 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 is supported by the government, with the formation of a dedicated ministry for its development. Despite government efforts, both rural and urban households still prefer conventional allopathic treatment over AYUSH, states an ET report.

ALSO READ | IRDAI's draft guidelines to protect insurance policyholders: 5 key changes to know
Aligning AYUSH with conventional treatments
IRDAI has advised all insurers to comply with the following guidelines, which will take effect from April 1, 2024.

Board-approved policy: To ensure policyholders have the freedom to choose their treatment, insurers must establish a Board-approved policy for providing AYUSH coverage. This policy should detail how AYUSH treatments will be treated equally with other treatments for health insurance purposes.
Product modification: Insurers must revise their current products that impose restrictions on AYUSH treatments and ensure they comply with the directives.
Quality parameters: The policy must include quality standards and procedures for enrolling AYUSH hospitals and day care centers as network providers for offering cashless services. Insurers must also establish sufficient controls and SOPs.
Standard Operating Procedures (SOP):

Insurers should establish procedures for enrolling hospitals into their network.
They should include relevant clauses in their health services agreements with AYUSH Hospitals/Day Care Centers.
Insurers must define standard treatment protocols.
They should have measures in place to address potential fraud and abuse of the system.

AYUSH Treatment insurance coverage
Health insurance covering AYUSH treatments typically includes the following:

Expenses incurred at government hospitals accredited by the National Accreditation Board of Health (NABH) or the Quality Council of India (QCI).
In-patient treatment expenses at NABH and QCI-accredited facilities offering Ayurveda, Yoga, Unani, Siddha, and Homeopathy therapies.
Enrollment fees at Yoga institutes within the policyholder's state as part of preventive wellness measures.

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