Now Reading: IRDAI rules: Ayurveda treatment now covered under health insurance
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IRDAI rules: Ayurveda treatment now covered under health insurance
Ayurvedic treatment is now covered under many health insurance policies, following a directive from the Insurance Regulatory and Development Authority of India (IRDAI) requiring insurers to treat AYUSH therapies on par with…
Ayurvedic treatment is now covered under many health insurance policies, following a directive from the Insurance Regulatory and Development Authority of India (IRDAI) requiring insurers to treat AYUSH therapies on par with conventional medicine. Coverage applies only when the treatment is medically necessary and performed at a government-recognised hospital, ideally one with NABH accreditation. Inpatient care is typically covered, while outpatient visits, consultations, pharmacy purchases, and spa-style therapies are not.
Policyholders can claim benefits through two routes: cashless, if the hospital is within the insurer's network and pre-authorisation is obtained, or reimbursement, where the patient pays upfront and files a claim later with all bills, prescriptions, and discharge summaries. Insurers reject claims from unrecognised centres or for cosmetic, experimental, or wellness procedures. Panchakarma detox is covered only when prescribed for a genuine medical condition and involves a hospital stay. Commonly accepted conditions include skin disorders, stress-related issues, lifestyle diseases, metabolic disorders, digestive problems, chronic musculoskeletal conditions, and rehabilitative therapies.
Indian Opinion Analysis
The Insurance Regulatory and Development Authority of India (IRDAI) mandated in 2020 that insurers offer AYUSH coverage on a parity basis, meaning policies that cover hospitalisation must extend the same to AYUSH treatments. This directive reshaped the health insurance market, but adoption remains uneven: many policies still impose sub-limits or require treatment only at empanelled hospitals. For policyholders, the key constraint is the definition of medical necessity. Insurers typically rely on an AYUSH physician's certification that the treatment is curative, not preventive or wellness-oriented. The next milestone to watch is whether IRDAI mandates a standard list of covered AYUSH procedures, which would reduce claim disputes.
Source: livemint.com
This brief was synthesised by AI from the source linked above.
