Avail AYUSH benefits from your
health insurance plans

Health insurance plans should provide comprehensive coverage which aims to uplift the well-being of the insured. Allopathic medicines alone may not provide holistic healing for many of the diseases, including the ones that are attributed to lifestyle. There is a growing trend of people turning to alternate sources of medical treatment for lifestyle diseases. Many of the practitioners in this space indicate that by making lifestyle changes and altering food habits, one can reverse many of the lifestyle diseases such as diabetes, thyroid, cholesterol etc.,  In an attempt to uplift our traditional medicines and practices, the IRDAI in the year 2013, mandated that the insurers should provide AYUSH treatment as part of their coverage.

What is AYUSH?

AYUSH stands for Ayurveda, Yoga, Unani, Siddha and Homeopathy, the legacy of alternate medicine some of which were originated in India. These medicines/treatments are alternates to allopathic sciences. The Government has been keen on uplifting this segment of alternate medicine and hence, has instated the Ministry of AYUSH which oversees the development of alternative medicine in the nation. Despite multiple efforts, both rural and urban households are more inclined to allopathic treatments and medicines, primarily due to the immediate relief that one can gain from these treatments. The inclusion of AYUSH as part of the health insurance plans was a big boost to this segment, given that many of these treatments do not have any side effects, many among the younger generation have turned to these alternative medical treatments.

The National Health Policy, 2017 advocates the transitioning of alternate medical treatment as a mainstream healthcare option within an integrative healthcare system. The context of AYUSH is extremely extensive and can make way for equitable and affordable access for medicare among individuals with varied economic statuses. NHP is a powerful policy that endorses ‘medical pluralism which is the need of the hour in an already overwhelmed public healthcare system. This ideology of medical pluralism can be achieved by bringing in educational reforms in medical studies. All the streams of medical treatment must work in conjunction unlike now when allopathy, Ayurveda, yoga, Unani, Siddha, homoeopathy are working in silos.

Importance of AYUSH health insurance services in India

It was a significant step by the IRDAI to propose the inclusion of AYUSH health treatments in health insurance plans. The treatments and bio-medicines that are included under the AYUSH treatment are those therapies that have been a result of thousands of years of practice by rishis and our ancestors. All the therapies that are included in the AYUSH treatment are those which have a proven record of resolving the ailment with minimal side effects. The health insurance policies allow claims of AYUSH treatment which is undertaken along with allopathic mainstream treatments for critical illnesses. Combining AYUSH treatments along with mainstream treatment has a proven record of remarkable results and hence, the IRDAI allows such claims to be honoured.

Inclusion under the AYUSH Benefits

Given the steady growth in acceptance of the AYUSH line of treatments, the insurers have been launching competitive plans which will not only appeal to more people but will also enhance the comprehensiveness of the coverage of the health plans. The health plans offering AYUSH health coverage include:

• Coverage range between 2500 – 20,000 depending on the type of plan, the limit can be customised (increased) if required based on the mandate of the insurer.
• All alternate lines of medical treatment are covered in the policy.
• Alternate medical treatment includes all in-patient treatment undertaken under Ayurveda, Yoga, Unani, Siddha and Homeopathy.
• Enrollment fee paid towards Yoga sessions in a registered yoga institute, even if this is undertaken as a part of preventive wellness initiative.
• Fees related to yoga, part of holistic wellness for improvement of ailment as an add-on are also allowed as reimbursements.

The AYUSH cover provides individual health insurance benefits for all relevant treatment expenses. It reimburses AYUSH expenses to a predetermined limit. The limit is usually expressed as a percentage of the sum assured. The average range of such a limit has historically been 7% to 25% of sum assured. Things are slowly transforming, many of the insurers are now offering cover which offers claims to the extent of the entire sum assured.

Exclusions of AYUSH treatment:

The claims made against AYUSH treatment is settled or honoured only if such AYUSH treatment is reimbursed when the insured undergoes the treatment in a government-approved hospital or centre. AYUSH does not cover treatment expenses that are associated with the mere evaluation of the general check-up of the insured. Treatment at centres that are not approved by the Government, which do not have a valid license and are not a hospital is treated as exclusions.

The other exclusions are:

• Any hospitalisation for less than 24 hours time period
• Daycare procedures, outpatient medical expenses, pre and post hospitalisation expenses are not covered under alternative treatment and hence, not allowed under AYUSH cover
• Rejuvenation treatments or preventive wellness treatments which are not considered medically necessary are not allowed
• No cashless benefit among most of the health insurance companies for AYUSH treatments

The type of centres which allowed for treatment under the AYUSH scheme are:

• Teaching hospitals recognised central council of Indian medicine and the central council of homoeopathy
• Registered Government AYUSH hospitals under appropriate Act which fulfil the minimum criteria to qualify as a hospital:
  
  • Minimum 15 in-patient beds
  • Minimum of 5 qualified and registered AYUSH doctors
  • Availability of paramedical staff at all times
  • Separate AYUSH therapy sections
  • Patient’s daily record maintenance, access to an insurance company
  • More than 24 hours of hospitalisation in the aforesaid type of hospital

Why should you consider AYUSH Cover?

There are a few differences between the conventional health insurance cover and AYUSH cover, the prominent ones are mentioned below:

1. The cost of treatment is generally low as compared to that of allopathic treatments
2. Health insurance cover for AYUSH treatment is generally provided for all locations, the treatment is available at most locations
3. There is better accessibility of desired treatment due to many recognised/ registered centres mushrooming across various locations
4. Treatment is known to be effective, despite the longer duration of the treatment
5. Many of these alternative treatments generally do not have side effects, having an option of choosing alternative treatments and continuing to enjoy health coverage can be useful
6. These treatments are considered to be milder in comparison to allopathic treatments, the unsuitability of the treatment is unlikely to have any life-threatening damage

How is AYUSH treatment different from conventional health treatment?

While there continues to be a place for allopathic treatment, there is a growing demand for AYUSH treatment as well. Below are some instances when AYUSH treatment should be considered in place of allopathic treatment.

• It allows for a more holistic approach towards healthcare, clubbing conventional along with AYUSH treatments are likely to provide desired results
• Charts out a permanent resolution to the ailment by providing long term relief, without focusing on short term reliefs and quick fixes
• Very low side effects vs. conventional treatment methods
• Suitable for the elderly, due to lower side effects and affordability
• Suitable for lifestyle issues that would have to be otherwise managed by lifelong medicines
• Reversal of a few lifestyle diseases such as diabetes and hypertension can be managed by AYUSH treatment

How to choose the right AYUSH cover?

Like all other forms of insurance plans, there are many options from various insurance houses. The aspects that one needs to consider whilst choosing the right AYUSH cover are:

• Inclusions and exclusions
• Comparative features, benefits and premiums
• No claim bonus
• Network centres allowed for AYUSH treatment
• Claims ratio
• Claims management procedure and duration
• Type of settlement – reimbursement vs. cashless
• Check for sub-limits, co-payments, room rent

Availability of and eligibility for AYUSH healthcare services:

The Ministry of AYUSH and the National Board of Hospitals (NABH) have initiated the implementation of quality healthcare standards for hospitals that provide AYUSH treatments. More than 50 hospitals across India provide authentic, standardised and authentic AYUSH treatments.

If you are aged between 18 years and 65 years, then you can avail of AYUSH cover from any competent insurer. The plan is valid for a tenor of 1 year and can be renewed subsequently. Typically, AYUSH cover has a waiting period of 4 years for pre-existing diseases.

How to apply for AYUSH cover?

Many of the processes related to health insurance have transformed to become paperless, cashless and contactless.

• Application form can be filled out online which captures basic details and information pertaining to health status, family history etc.,
• Submission of basic ID proof, address proof and income proof via the online platform
• Authentication of application that is submitted – this is done via email or OTP on a mobile phone
• Based on the sum assured chosen, the premium is calculated
• Payment can be made via NEFT, UPI, mobile wallet or any other online payment mode, it can also be made via credit/debit card
• Details of membership after due diligence will be shared via email/ WhatsApp
• Hardcopy of the policy document will be couriered to the registered address

Many insurers are providing AYUSH treatments, some of the popular ones are HDFC Ergo, Cholamandalam MS insurance, Star Health, Apollo Munich etc., Most of them offer similar features and benefits, there are only minute differences, it is important that you carefully evaluate the plans by comparing them on authentic websites which provide a comprehensive comparison.

Key deterrents in AYUSH cover

1. Despite the numerous benefits extended, conventional insurance policies are more popular. This is primarily because people still lean towards allopathic treatment, on some occasions, the need for health cover for alternative medicine is considered to be futile due to lower costs. However, people often do not realise that alternate treatment lines are long drawn processes and these could add up to substantial expenses over the long haul.
2. The lack of cashless benefit is a major deterrent, the subsequent submission of claim documents is cumbersome. Further, there is the chance of claim rejection based on some pretext. Some of these gaps have to be fixed adequately to ensure that there are more takers for AYUSH cover.
3. Some of the health insurance companies that offer AYUSH benefits have a mandatory co-payment clause. In such a scenario, the insurer will honour only a part of the claim amount subject to the pre-determined, admissible claim limit. The insurer will be allowed to pay only the remaining.
4. Many of the insurance policies do not entertain dual claims for the same medical ailment, it is important to understand the clauses to ensure that an individual can claim for both allopathic treatment and AYUSH treatment concerning the same ailment.
5. There are also instances when AYUSH cover honours the only alternative treatment and mainstream allopathic treatment claims are not entertained. These are nuances that the individual has to be well aware of and choose the one that aligns well with his requirement

Challenges faced by insurers

1. Ascertaining the authenticity of AYUSH practitioners, there is much alternative medicine that provides the required relief to the ailment. However, the authenticity of the practitioners cannot be established. This has remained the most significant challenge for insurers
2. Misuse and abuse of terms of alternative treatments is another challenge that insurers have not been able to overcome. It is a fact that these medical treatments are generally long-drawn, there is the possibility of misuse of such terms. Limited resources are available to identify the right place where authentic treatment is given. This is one of the reasons that the network hospitals for alternative medical treatment are much lower than the conventional hospitals.
3. The quality of the drug cannot be controlled or standardised, many times the medicines are customised as per individuals conditions and preferences. This makes it tough to establish a standard process and line of treatment for ailments

Future of AYUSH Cover:

As a recent development, the Government initiated that all insurers will offer a standardised health insurance plan called the Arogya Sanjeevani. This initiative has been operational since April 2020, this insurance product will cover AYUSH treatments up to the sum insured. While many other insurance products covered AYUSH treatment, often they come with sub-limits and such limits are levied as a percentage of the sum insured. This move comes on the backdrop of a phenomenal increase in demand for alternate medical treatments and the intent to uplift these medical segments by the Government. The minimum sum assured for Arogya Sanjeevani is stipulated at a minimum of Rs. 50,000, if such policy is availed then the upper limit for claims for AYUSH treatment is at 100% of the sum assured which is typically unavailable with other insurers. The Arogya Sanjeevani as a product is introduced to make health insurance more affordable and to standardise the benefits offered across insurers. This is one step towards universal health coverage.

Suitability analysis

Alternative medical treatment can be a powerful method to overcome lifestyle diseases, there is also evidence of some severe ailments costing much lower in the alternate medical treatment. The fact that it has very less side effects and is suitable for all ages, makes it an interesting proposition. The plan is suitable for the elderly who are more sensitive and could have life-threatening side effects. However, one should choose a plan which offers a comprehensive cover – both allopathic and AYUSH treatment claims are honoured simultaneously for the same ailment.

Frequently Asked Questions

1. What is AYUSH treatment?
   AYUSH stands for Ayurveda, Yoga, Unani, Siddha and Homeopathy. It is the legacy of alternate medicine some of which were originated in India.

2. What is the minimum number of hours of hospitalisation for claiming AYUSH benefit?
   Any hospitalisation for more than 24 hours time period qualifies for claiming AYUSH benefit

3. What is the eligibility to avail of AYUSH cover?
   If you are aged between 18 years and 65 years, then you can avail of AYUSH cover from any competent insurer. The plan is valid for a tenor of 1 year and can be renewed subsequently.

4. What benefits are offered under AYUSH cover?
   Benefits offered under AYUSH are:
   
   1. Coverage range between 2500 – 20,000 depending on the type of plan, the limit can be customised (increased) if required based on the mandate of the insurer.
   2. All alternate lines of medical treatment are covered in the policy.
   3. Alternate medical treatment includes all in-patient treatment undertaken under Ayurveda, Yoga, Unani, Siddha and Homeopathy.
   4. Enrollment fee paid towards Yoga sessions in a registered yoga institute, even if this is undertaken as a part of a preventive wellness initiative.
   5. Fees related to yoga, part of holistic wellness for improvement of ailment as an add-on are also allowed as reimbursements.
5. What are the key exclusions of AYUSH control?
   The exclusions of AYUSH control are:
   
   1. Treatment is undertaken in centres other than recognised AYUSH centres.
   2. Any hospitalisation for less than 24 hours time period.
   3. Daycare procedures, outpatient medical expenses, pre and post hospitalisation expenses are not covered under alternative treatment and hence, not allowed under AYUSH cover.
   4. Rejuvenation treatments or preventive wellness treatments which are not considered medically necessary are not allowed.
   5. No cashless benefit among most of the health insurance companies for AYUSH treatments.
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