Coverage For Alternative Treatments Under Health Insurance

India has numerous ancient medical practices, including Ayurveda, Siddha, and others. Therefore, it may not be a revelation that many individuals favour alternative therapies over modern ones. Many consider these to be safer because they have almost no adverse effects. Alternative medical care is more affordable than surgical procedures and other advanced allopathic treatments. However, does health insurance medical coverage include alternative therapies?

Is coverage for alternative therapies included in Indian health insurance?

Yes, alternative remedies are covered by health insurance plans in India. The Insurance Regulatory and Development Authority of India (IRDAI) considered AYUSH treatments for insurance coverage in 2013. In a policy document provided by the AYUSH Ministry, the diseases, specific medications, treatment methods, average duration of hospitalisation, and other costs the health insurance plan could cover were all detailed. These costs are covered by the “alternative treatment benefit” of an insurance policy. However, the policyholder must fulfil certain requirements to claim treatment costs under the policy. *#

An insurer will only cover treatment costs if a certified medical practitioner prescribes the treatment in writing.

The following criteria must be taken care of for a treatment to be considered medically necessary:

1) It adheres to industry standards widely acknowledged by the Indian medical community or international clinical practice.

2) It is recommended by a doctor who is not a relative of the insured and is necessary to treat an ailment or injury sustained.

3) In terms of scope, duration, and intensity, it is, at most, the minimum level of care required to provide practical, safe, and acceptable medical coverage.*

  • You may only receive treatment at an AYUSH-accredited hospital.

An AYUSH hospital operated by India’s national or state government should provide alternative medical care. If you receive treatment at a different hospital or outside of India, the insurer is not obligated to pay out.*

  • The cost of treatment should not be excessively inflated.

No statute restricts the amount a hospital may charge for a specific service. Insurers can protect themselves against irrational hospital invoicing through the reasonable and customary clause. *

They determine reasonable prices for a treatment based on the range of prices charged by hospitals in a given region. The insurer will only pay the average cost if the hospital bill for the alternative treatment exceeds the amount.*

 Which is the best medical insurance? Considerations before purchasing AYUSH coverage under health insurance:

  • There may be a maximum claim amount for AYUSH services. Before making a purchase, it is essential that you carefully examine the health insurance plan.
  • Although many health insurance companies now offer coverage for AYUSH treatments, not all insurers may provide this coverage. If you intend to receive AYUSH treatment in the future, you should purchase a health plan from an insurer that includes this coverage.
  • An individual health insurance plan for AYUSH treatment is currently unavailable. Therefore, you must purchase a standard health insurance policy with AYUSH coverage.
  • A minimum of twenty-four hours of hospitalisation is required to qualify for AYUSH benefits under a health plan.*
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* Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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