Tough rules for AYUSH treatment make health cover difficult

IRDA’s condition that treatment under AYUSH has to be at a government hospital or an institute recognised by the government makes insurance cover difficult.

Insurance companies have started coming out with policies covering alternative treatments after the new health insurance regulations earlier this year allowed coverage for AYUSH (ayurveda, siddha, unani and homeopathy) treatment.

Religare Health Insurance recently launched a version of its healthcare plan, Care, covering AYUSH treatment.

“There is a renewed focus on alternative treatment. That is why we are offering AYUSH coverage in our enhanced plan,” says Anuj Gulati, MD and CEO, Religare Health Insurance.

Insurers, however, are taking baby steps towards it. Based on the sum insured, the cap starts at Rs 15,000 and goes up to Rs 50,000. This means that even if you opt for the highest sum assured under Care, which is Rs 75 lakh, the maximum amount you will get for AYUSH coverage is only Rs 50,000, or less than 10 per cent of the sum assured. 

This is the biggest drawback of such policies, says Mahavir Chopra, director-health, life and strategic initiatives, Coverfox, an insurance broker.

“Most of these plans don’t give full cover on the sum assured. The cover can be low in case of hospitalisation. Some companies offer it as a percentage of the sum assured, say 10 per cent. In such a case, if you take a Rs 10 lakh cover, you can get up to Rs 1 lakh for AYUSH treatments.”

Bajaj Allianz General Insurance’s Health Care Supreme offers this product. The good news here is there is no cap on the sum assured and consumers can claim up to whatever sum assured they have opted for.

Rashmi Nadargani, vertical head-health underwriting, Bajaj Allianz General Insurance, says: “We cover all ailments that are covered under allopathy and not the kind of treatment. The kind of treatment is the doctor’s protocol. We want to give the consumer the flexibility to undergo whatever treatment wherever he wants to get cured.” 

However, there is no cashless facility for AYUSH treatment and it is only on reimbursement basis. “This is because most ayurvedic hospitals find it difficult to meet the criteria required for empanelment of hospitals. These include a certain minimum number of beds, 24-hour monitoring, emergency care, registration of the hospital, qualified doctors, etc,” explains Nadargani.

As claims have to be approved on the basis of the patient’s history and the kind of treatment, insurers need to check whether the disease is eligible for coverage. A lot of treatment might be done for cosmetic and wellness purposes, too. Also, insurers check if hospitalisation is needed or it can be treated in the out-patient department. Religare offers cashless facility for AYUSH treatment, but only at its network hospitals.

Besides these complications, the Insurance and Regulatory and Development Authority of India’s condition that cover can be provided for AYUSH treatment but the treatment has to be at a government hospital or an institute recognised by the government or accredited by the Quality Council of India or the National Accreditation Board on Health will make things difficult.

“Ayurveda can be very open-ended. There are several spa-like centres that offer such treatment. Hence this condition that treatment should be only at government- recognised hospitals,” Chopra adds.

Image: Crystal Therapy at the spa facility in ITC Grand Central, Mumbai (image used for representational purposes only). Photograph: Courtesy ITC Grand Central, Mumbai/Luxury Collection Hotels and Resorts