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Can we claim the Ayurveda treatment cost under a health insurance if we are admitted in an Ayurveda hospital?

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In recent times, the medical sector has witnessed a paradigm shift of sorts with patients and their caregivers showing great faith in alternate treatments. AYUSH, short for ‘Ayurveda, Yoga, Unani, Siddha and Homeopathy’ systems of healthcare found a boost when the Insurance Regulatory and Development Authority of India (IRDAI) in 2013 asked insurance providers to cover treatment based on these alternate methods. However, policyholders still have some doubts regarding whether their insurer will provide them coverage for AYUSH for not. Also, there seems to be a lack of clarity regarding what all is covered if AYUSH benefit is promised as part of the health insurance policy. Let’s discuss all that and more.

What is AYUSH benefit in health insurance?

To promote and regulate alternative systems of medicine, the Government of India formed a special ministry, the Ministry of AYUSH, in 2014. The medicines used for AYUSH treatments have minimal or no side-effects as they are made of natural ingredients. Considering the rise in popularity of alternative treatments, the Insurance Regulatory and Development Authority of India (IRDAI) directed all general insurance companies to include AYUSH treatments in their health insurance policies. Many health insurance providers are now offering policies with AYUSH benefits that cover treatments, therapies and medicines.

Benefits of AYUSH Treatment 

• It is backed by ancient Indian science.
• It is considered the best alternative for those who have allergic reactions to allopathy, especially elderly people.
• It takes a holistic approach towards healthcare as it focuses not just on recovery but the overall wellbeing of the patient.
• Yoga and meditation are quite helpful in controlling or eliminating lifestyle-related issues like obesity, tobacco addiction, diabetes, hypertension, and substance abuse.
• This treatment aims to eliminate the root cause of the disease instead of finding makeshift solutions.
• It heals with ease.  
• Lastly, AYUSH treatments are cost-effective and likely to have lesser side effects.

Who can avail for AYUSH treatments in health insurance?

Anyone who has opted for AYUSH cover while purchasing their health insurance policy can avail AYUSH benefits. However, experts highly recommend this for those aged 60 and above. If you are including your parents in your health policy or buying a separate senior citizen policy, make sure that AYUSH cover is a part of the policy.

Also Read: Why Opt for Health Insurance with AYUSH Benefits ? 

What is covered under AYUSH benefit in health insurance?

All medical expenses incurred for in-patient treatment under AYUSH will be covered. However, the treatment must be done at a government hospital or at any institute recognized by the government and/or accredited by Quality Council of India/National Accreditation Board on Health (NABH).

What is not covered under AYUSH benefit in health insurance?

• If the treatment has been done at a hospital/healthcare facility that is not recognized by the government, expenses will not be covered.
• The policy will not cover expenses if you have not been hospitalised for atleast 24 hours.
• Daycare procedures, pre and post hospitalisation charges, and outpatient medical expenses while undergoing alternative treatment are excluded.
• Spas, massages and other rejuvenation treatments that are not medically necessary won’t be covered.
• Hospitalisation expenses for only evaluation or investigation are excluded.

What are the conditions to be kept in mind to avail ayurvedic treatment in health insurance?

How will you feel if you find out that your insurance provider has rejected your claims for ayurvedic treatment and despite the fact that you have a comprehensive health insurance policy? You will be shocked, right? Well, if you don’t want your claims to be rejected, keep the below conditions in mind:

1. AYUSH cover should be included in your health insurance policy and you have to pay extra premium for that.
2. All treatments should be done at a hospital/healthcare facility that qualifies under AYUSH treatment.
3. All AYUSH hospitals should have the below criteria:
   • Dedicated AYUSH therapy sections
   • Minimum 5 qualified and registered AYUSH doctors
   • Minimum 15-bedded hospital
   • Qualified para-medical staff 24*7
   • The hospitals should maintain a daily record of patients and share these with the insurance company.
4. At least 24 hours of hospitalisation is required to claim for the expenses.

Conclusion

It is true that allopathic medicines often give quick relief from many ailments. However, alternative systems of medicine like Ayurveda and homeopathy are gaining popularity mainly because they follow a holistic approach and the medicines are made of natural ingredients that can be easily absorbed by the human body. But before you claim your medical insurance for the expenses incurred due to AYUSH treatments, keep the abovementioned points in mind for hassle-free claim settlement.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

 

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