AYUSH health insurance: Understand the nitty-gritties before making a claim

Does your health insurance policy cover AYUSH treatment

India has a rich culture and history of traditional medicine, with ayurveda, homeopathy, yoga and other alternative therapies playing a significant role in healthcare.

Until recently, getting insurance cover for these treatments was cumbersome. However, in 2013, the Insurance Regulatory and Development Authority of India (IRDAI) initiated coverage for AYUSH (ayurveda, yoga & naturopathy, unani, siddha, and homeopathy), making alternative healthcare more accessible. This shift is bridging the gap between conventional and traditional medicine, providing policyholders with comprehensive medical options.

According to a 2024 survey by the National Sample Survey Office (NSSO), nearly 95 percent of rural and 96 percent of urban respondents were aware of AYUSH practices. And about 46 percent of rural and 53 percent of urban individuals had turned to AYUSH for preventive or curative purposes in the year prior.

AYUSH includes a variety of  therapies from different traditional systems. They are also relied upon to support recovery after hospitalisation. Each of these systems offers unique benefits and can play a significant role in holistic healthcare. Patients can select what best suits their condition.

Also read: Govt plans to include 170 AYUSH packages in AB-PMJAY, stores for traditional medicines in tehsils

AYUSH health insurance

Many health insurance companies today provide coverage for AYUSH treatments up to the sum insured by the policyholder. Some insurers may impose an upper limit on the amount, or the limit could be specified as a lumpsum or a percentage of the sum insured. Therefore, if a policyholder files a claim for ayurvedic or homeopathic treatment, it will be settled according to the limits specified in the policy. Hence, policyholders should check their policy details to understand the sum insured and if any sub-limits are applicable on AYUSH treatments.

Also read: How to get cashless treatment at any hospital: Health insurance rule changes explained

How to file a claim for AYUSH treatment

To claim expenses for AYUSH treatment procedures, hospitalisation for at least 24 hours in any government recognised AYUSH hospital or institute is mandatory. If the purpose of hospitalisation is only medical evaluation, then the claim will not be covered by the insurer. Also, treatments that focus on rejuvenation of the body are generally excluded from the cover, meaning that therapeutic or wellness-related expenses must be borne out of one's pocket.

Who is eligible for AYUSH health insurance?

Many private health insurance providers offer AYUSH cover through standard policies, add-on options, or separate plans. The coverage limits and eligibility criteria for these plans are outlined in the insurance plan's terms and conditions. AYUSH health insurance is also available to serving and retired central government  employees covered by the Central Government Health Scheme (CGHS). Additionally, several state government insurance schemes, such as Arogyasri in Andhra Pradesh and Ayushman Bharat in certain states, cover AYUSH treatment.

As India continues to adopt integrative healthcare, the inclusion of AYUSH in medical insurance ensures that policyholders get access to a wider range of treatment options.