IRDAI mandates inclusion of AYUSH treatments under health insurance cover

AYUSH encompasses alternative therapies rooted in Ayurveda, Yoga, Unani, Siddha, and Homeopathy. The regulatory move comes in response to the escalating popularity and widespread adoption of AYUSH treatments. The directions issued on Jan 31 will come into effect from April 1, 2024.

Acknowledging the growing prevalence of these alternative therapies, IRDAI has deemed it essential to consider them equal to mainstream medical treatments in the context of health insurance coverage. The decision underscores a significant shift in the approach towards healthcare, recognizing the holistic benefits and increasing acceptance of AYUSH practices in managing and preventing various health conditions.

By instructing insurance companies to extend coverage to AYUSH treatments, the regulator aims to cater to the evolving healthcare preferences of individuals, providing a more comprehensive and inclusive health insurance landscape. 

As per a recent media report by Live Mint, the IRDAI circular says, “The insurance companies will have a board-approved policy for providing AYUSH coverage which will include their approach towards placing AYUSH treatments at par with other treatments for the purpose of health insurance so as to provide an option for the policyholders to choose treatment of their choice."

“The policy will also contain the quality parameters as well as procedure for enrolling AYUSH hospitals/daycare centres as network providers for the purpose of providing cashless facilities," the circular adds.

The circular outlines specific areas where insurers are required to establish controls, including the enrollment of AYUSH hospitals into their network. Additionally, insurers must incorporate necessary clauses in their health services agreements with AYUSH hospitals and daycare centers. Standard treatment protocols are to be defined, ensuring a systematic approach to AYUSH treatments. The directive also highlights the importance of addressing potential frauds and abuses within the system, reports the Daily. 

To facilitate the seamless integration of AYUSH coverage, the Ministry of Ayush took a significant step on October 4, 2023, by establishing a 'Core Group of Experts for Insurance Sector.' This expert group, equipped with domain knowledge, will play a pivotal role in shaping the modalities required for effective AYUSH coverage within insurance policies.

Furthermore, insurance companies are urged to actively engage with the established expert group to collaboratively develop the necessary frameworks and protocols for extending coverage to AYUSH treatments. 

Also Read: Delhi HC dismisses plea seeking inclusion of Ayurveda, Yoga in Ayushman Bharat