In India, AYUSH is an abbreviation for the medical model that includes Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy. These methods of medical treatment are based on the philosophies for achieving good health and aims to create a holistic lifestyle for patients by incorporating traditional and modern treatment methods.
On 9 November 2014, the Ministry of AYUSH was developed to promote this form of conventional medicine in order to encourage the expansion of the AYUSH health care system. In the same year, the Indian government also launched the “National Ayush Mission (NAM)” to facilitate and enhance the scope of alternative methods of medical treatments.
Scope of AYUSH under health insurance
Over the years, the AYUSH clinicians have also expressed concern about insurers that do not cover these forms of treatment under health insurance policies. In its 2013, The Insurance Regulatory and Development Authority of India (IRDAI) recommended that insurance companies must cover this diverse treatment approach in their regular health insurance plans.
Certain health insurers, on request from the customer, provide protection for non-allopathic therapies under group health plans. Most companies are now also offering AYUSH benefits within an individual health insurance plan. There are also health insurance policies which only provide coverage for a particular form of alternative therapies such as Ayurveda.
Health insurance plans for AYUSH typically cover costs for alternative treatments only if they are undertaken in a government hospital or in any healthcare institution accredited by the Indian government and/or by the Indian Quality Council / National Health Accreditation Board (NABH).
AYUSH medication expenditures are compensated up to the specified limit of the insured sum and are limited to a percentage varying from between 7 to 25 percent on plan and insurer basis. Some insurance companies fix a standard rate as a sub-limit to claim under AYUSH benefit. Some providers may even charge a premium that is 5 to 10 percent higher than the normal premium rates to include AYUSH benefit within the standard health plan.
Most health plans encompass AYUSH medication under the benefit of in-patient hospitalization, where the client has to be admitted to a certified hospital for more than 24 hours to even get the claim. The provision of non-allopathic treatments under out-patient cover remains a major constraint under health insurance policies, and AYUSH majorly requires an out-patient cover to be included in these insurance plans
Although the likely increase in alternative therapies and practitioners in Indian healthcare offers tremendous room for treating multiple diseases through AYUSH, insurers often refuse to provide it as a standard benefit under a basic health plan. With the government’s effort of making AYUSH medical care a substantial part of Indian health system, the opportunity for new innovative health insurance plans offering AYUSH at a decent cost-benefit with minimum limitations and maximum coverage is now available but it is always advisable to read the documents thoroughly (even the fine print) and ask the insurer about the AYUSH benefit they offer.