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Unveil the scope of AYUSH under health insurance policy

With the growing popularity of alternative systems of medicine and the government‘s keen approach to expand and promote AYUSH as a cost effective means of treatment, including such treatments as a mainstream benefit of health insurance policy has become imperative.

November 09, 2016 / 02:30 PM IST

Harjot Singh NarulaComparepolicy.comIndia has a rich legacy of medical wisdom carried forward from the ancient times in the form of holistic treatments like AYUSH. AYUSH is an acronym of the medical approach which is followed in India as Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy. These medical treatment systems characterize a way of healthy living to prevent any health hazards and are grounded on the medical philosophies for the attainment of good health. To promote this form of alternative medicine, the Ministry of AYUSH was conceptualized on 9th November 2014 to induce the growth of AYUSH system of health care. The Indian government had also kicked off the “National Ayush Mission (NAM)” in 2014, to promote and magnify the scope of alternative forms of medical care.Scope of AYUSH treatment under health insuranceWith the growing popularity of alternative systems of medicine and the government’s keen approach to expand and promote AYUSH as a cost effective means of treatment, including such treatments as a mainstream benefit of health insurance policy has become imperative. The Ayush practitioners have also raised concerns about insurers not covering the alternative forms of treatment as an out-patient and in-patient benefit under Health insurance schemes. The Insurance Regulatory and Development Authority of India (IRDAI) in its Health Regulation, 2013 had suggested the Insurance companies to include this pluralistic approach of treatment under their standard health insurance plans.Some insurance companies do offer cover for non allopathic treatments under group health policies on client’s request. AYUSH benefit is now being included by many insurers under individual health insurance plan as well. There are health insurance plans which offer coverage only for a specific form of alternative treatments like Ayurveda.Insurance companies provide AYUSH benefit as per their own specific scope of coverage under the health insurance policies.AYUSH Coverage & Limitations• AYUSH treatment expenses are reimbursed up to the specified limit of the sum insured and are restricted up to a percentage of the sum insured ranging from 7% to 25% basis the plan and the insurer. Some insurers fix a standard amount as a sub limit to claim under AYUSH benefit.• Cashless treatment is offered by very few insurers and majorly the claim amount is reimbursed on submission of the requisite substantial documents.• The treatment has to be undertaken in a government hospital accredited by Quality Council of India or National Accreditation Board on Health to get the claim paid under your Health policy.• Compulsory co-payment clause (where the part of the admissible claim amount has to be borne by the customer) is applied under some health plans offering AYUSH benefit.• Most of the health plans cover AYUSH treatment under in-patient hospitalization benefit where the customer has to be hospitalized for more than 24 hours in the accredited hospital to get the claim. Providing non allopathic treatments under outpatient cover is still a major limitation under health insurance policies whereas, treatment under AYUSH majorly requires to be treated under out patient department.• Some insurers charge 5% to 10% higher premium than the usual premium rates for including AYUSH benefit under the standard health plan.• Once the claim for a specified disease has been taken under the non-allopathic form of treatment like AYUSH, the customer may not be allowed to claim for the allopathic treatment for the same disease under the plan during the policy period.• The facilities or hospitals providing such non allopathic forms of treatment are scarce and limited which restricts the availability of such treatments under your health insurance policy.The growing popularity and evident results under the non-allopathic forms of treatment for various diseases (like spondylitis, arthritis, epilepsy, gallstones, varied allergies and many others) are visible and acknowledged by many. The benefits are limited to some restrictions and sub limits, which undermines the coverage of such treatments. Insurance companies are still hesitant to include AYUSH treatment as a mainstream benefit.The cost of AYUSH based treatments vary widely, which makes it difficult for the insurers to ascertain the underwriting guidelines and premium amount.Health Plans with AYUSH BenefitHDFC Ergo Health Suraksha Plan – Medical expenses incurred for in-patient treatment up to 7.5% of the sum insured are reimbursed under AYUSH benefit.Tata AIG MediPrime Plan– In-patient treatment up to the maximum amount of Rs 25,000 are reimbursed under AYUSH benefit.Star Health Medi- Classic Insurance Plan - AYUSH treatments are covered up to 25% of the sum insured subject to Rs 25,000 per policy period.Apollo Easy Health Insurance Plan –AYUSH benefit under this plan can be availed as an in-patient treatment. Benefit ranges from Rs 20,000 to Rs 50,000 depending on the plan variant and the sum insured.Chola MS Individual Healthline Insurance Policy – Offers cover for Ayurvedic treatment with benefits up to 7.5 per cent of the sum insured (specific treatments only) along with a 20% co-payment clause.New India Insurance Mediclaim Policy- Offers cover for AYUSH treatment with a capping of up to 25 % of the sum insured.ConclusionThough, the probable elevation of alternative therapies and practitioners in Indian healthcare gives an enormous scope for the treatment of multiple diseases through AYUSH, still the insurers are hesitant to offer is as a conventional benefit under a basic health plan. With limited and scarce AYUSH treatment dispensaries and hospitals, depending solely upon the non allopathic forms of treatment is shaky.With the government’s projection of making AYUSH treatment as a substantial part of Indian Health care systems, there is a scope of new innovative Health Insurance plans offering AYUSH benefit at a nominal cost with minimum limitations and maximum coverage.It is important that you read the fine print keenly to know the scope of such treatments under your Health Plan before buying to avoid surprises in the event of any claim.