Individual Insurance

Considering the popularity of alternative treatments in India, various health insurance companies have started offering AYUSH benefit to their policyholders. In its health regulation, 2013, the Insurance Regulatory and Development Authority of India (IRDAI) asked individual health insurance companies to include AYUSH, which stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy, under their policies.

Family Health Insurance

As per AYUSH coverage, medical expenses which are incurred on in-patient treatment under Homeopathy, Ayurveda, Siddha or Unani, are reimbursed under AYUSH.

In case AYUSH is covered under individual health insurance plan, it will have the following coverage and limitations –

  • Under its AYUSH benefit, the individual health insurance company covers AYUSH treatment expenses which are reimbursed up to the specified limit of the sum insured. Usually, it is restricted up to a percentage of the sum insured which varies between 7% to 25% of the plan
  • There are some health insurance companies which have defined a fixed limit for the sum insured that can be settled under AYUSH
  • Usually, very few health insurance companies in India offer cashless treatment, and majority of the claim is reimbursed when the insurer submits the important claim documents
  • To get coverage under AYUSH treatment, it is necessary that the treatment must take place in a government hospital accredited by Quality Council of India or National Accreditation Board
  • Some individual or group health insurance policies covering AYUSH benefit come with a mandatory co-payment clause. As per this clause, the part of the admissible claim amount has to be paid by the policyholder, and the insurer settles the remaining claim amount
  • In most of the cases, AYUSH treatment is covered as an in-patient hospitalisation where the policyholder has to be hospitalised for more than one day to get the claim settled under AYUSH cover
  • To get AYUSH cover, you would have to pay extra premium than what you would have paid in case of any other standard health insurance plan
  • In those situations, where a policyholder has got a claim settled under AYUSH, he/she can’t get the same treatment covered under the non-allopathic as well

Note, AYUSH will be covered only when it is included in a health insurance policy. As some insurers do not cover AYUSH, it would be good to have complete knowledge about it before going ahead.

Case: 1

Ajay, a 48-year-old IT Professional, was suffering from a chronic back pain which he developed due to his sedentary lifestyle. For one year, he went for non-allopathic treatment, and when nothing worked, he decided to go with ayurvedic treatment.

Read More: How is a Claim Payable under Worker Compensation Insurance if They Are also Covered under Health insurance?

He consulted an ayurvedic practitioner who thoroughly checked him and told that he would need eight sittings to treat his problem which would cost him Rs 50,000.

As Ajay had a comprehensive health insurance with a sum insured of Rs 5 lakh, he went ahead with the treatment, comforted by the fact that the sum insured was more than Ayurveda medical expenses.

However, he got a big shock when he came to know about a fact which he did not check before. Her health insurance policy had specifically kept AYUSH under exclusion list. It means the policy had clearly stated that it wouldn’t cover expenses which were related to Ayurveda, homeopathy or any other alternative treatment.

Case: 2

Ravina had a problem with high blood pressure and diabetes. One of her friends recommended an ayurvedic treatment to cure the ailment. She had a health insurance policy, and therefore, she carefully read the policy document to ensure it covers ayurvedic treatment as well. Luckily, her insurance policy was offering AYUSH coverage, and therefore, Ravina decided to go ahead with the treatment.

She chose a government hospital for her treatment which was accredited by Quality Council of India or National Accreditation Board.

As her treatment cost came to Rs 80,000, her health insurance had a co-payment of 20%, and therefore, she paid Rs 16,000, and the individual health insurance company settled the remaining, i.e., Rs 64,000 (80,000-16,000).

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