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Health insurance covering AYUSH


We will all agree that the enthusiasm engendered by Prime Minister Narendra Modi on World Yoga Day has fuelled the acceptance, popularity and attractiveness of alternative treatments such as AYUSH therapiesin the recent years.
Right from holistic products to treatment of chronic ailments, India seems to prefer the ‘natural’ method, considering it as a longer but more effective and sustained mode of treatment.
A survey by the research firm, Euromonitor revealed that over half of the Indian consumers reported ‘natural or organic’ features influencing their hair and skin care purchase decisions.Consumers have increasingly been adopting various AYUSH treatments especially homeopathic and Ayurveda treatment to cure major illnesses.
Given this trend, AYUSH treatments are now being offered by insurance companies under their comprehensive health insurance policy.
AYUSH means Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. The Ministry of AYUSH, Government of India, is involved in developing, educating and taking productive steps to expand this alternative treatment through health insurance products, both by public and private insurers.
The Ministry of AYUSH has recently issued Guidelines on Insurance Coverage for Ayurvedic Treatment and Settlement of Claims on the basis of benchmark rates of various therapies / interventions. Similar guidelines in context of Unani, Siddha, and Homeopathy are also expected to be issued soon by the ministry.
As of now we already have some insurance products in the market offering re-imbursement of AYUSH treatments. The industry is expecting that with the new guidelines coming from the government, AYUSH treatments will see more acceptance by the policyholders resulting in their long-term benefit.
Insurance companies will also design new products as per these guidelines which will help standardisation of AYUSH treatment coverage under the insurance framework.
AYUSH treatment under health insurance coverHealth insurance in India is primarily being offered by General Insurance companies as well as Specialist Health Insurance companies and many insurers offer products which cover expenses of treatment under components of AYUSH especially Ayurveda and Homeopathy.
However, most of the treatment as of now is covered where the hospitalisation treatment taken under these forms of medicine are being covered / reimbursed under the policies.
If any patient is advised Ayurveda treatment to cure his/her ailment and has chosen to cover AYUSH treatment under his/her policy, then the individual will get the reimbursement benefit as per terms and conditions specified in the policy opted by him/her.
Even individuals suffering from critical illnesses like cancer, stroke, heart disease, etc. who are advised to take Ayurveda services for proper recovery, can get reimbursement benefit if the alternative / AYUSH treatment plan is covered under the health insurance policy opted by the individual.
Additionally, due to prolonged sedentary lifestyle, a number of diseases and ailments have cropped up these days. AYUSH treatments have proven to be amongst the most beneficial methods for treatment of such conditions, which have been acclaimed across the globe.
Premium: The products for covering such treatment are generally priced taking into consideration the extent as well as components of AYUSH being covered under the product.
Benefits: Today, hospitalisation and standard treatments are very expensive making it less affordable to the larger section of the population. AYUSH treatment may be economical as well as have lesser side effects. It will also boost the functioning of Indian Medicine System. At an industry level, it may help in increasing the insurance penetration in the country.
While as of now most insurers offer this only under hospitalisation benefits we can definitely see a future where such alternative forms of treatment will find place under outpatient as well as wellness benefits which insurer devise.
Claim settlement process: Claims for AYUSH treatment can be filed with the insurer with the mandatory documents related to the hospitalisation including the original hospital bill, original discharge summary and investigation reports.
Treatment must be taken in government registered hospitals and proper medical records must be available for the given line of treatment. The ministry has issued guidelines for eligible hospitals for Ayurvedic treatment which include government hospitals, NABH accredited Ayurvedic hospitals, etc. Every insured should refer to the claims settlement procedure as well as documents required as per the policy he/she holds.
How to choose the insurer?
One should always buy insurance from a reputed insurer that has a good record of servicing and claim settlement, as these are the features that become critical when you are actually in need. A cheaper policy may not always be the best policy for you.
Choose a policy that suits your requirements in terms of coverage and sum insured. Please go through the prospectus and policy wordings to understand the waiting periods, exclusions and sublimit under the policy.
(The writer is Head – Health Insurance at Future Generali India Insurance Company)

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