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Are alternative treatments covered under health insurance?

Team AckoOct 14, 2022

India is home to many ancient health care approaches such as Ayurveda, Siddha, and more. So, it may not come as a surprise that a lot of people prefer such alternative therapies to modern ones. These are also perceived by many to be safer, as they have almost no side effects. Alternative medical care is also reasonably priced compared to surgeries and other advanced allopathic treatments. But does a health insurance policy cover alternative treatments? Read on to know more.

Are Alternative Treatments Covered Under Health Insurance?

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Is coverage for alternative treatments offered under Health insurance in India?

Yes, coverage for alternative treatments is offered under health insurance in India. AYUSH  (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatments were considered for insurance coverage in 2013 by the Insurance Regulatory and Development Authority of India (IRDAI). The diseases, specific medicines, treatment methods, typical length of hospitalisation, and other costs that might be considered for coverage under the health insurance plan were all specifically outlined in a policy document provided by the AYUSH Ministry. 

These costs are covered by an insurance policy's "alternative treatment benefit". However, the policyholder must fulfil certain conditions to claim treatment costs under the policy. 

Following are some examples. 

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

The following conditions should be met for a treatment to be termed as medically necessary.

  1. It complies with industry standards widely accepted by the Indian medical community or in international clinical practice.

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

  3. It does not go above the minimum level of care required to deliver effective, safe, and acceptable medical care in terms of scope, duration, or intensity.

  • You must avail of the treatment only in a registered AYUSH hospital.

Your alternative medical care should be provided in an AYUSH hospital run by the national or state government of India. The insurer is not liable to honour the claim if you receive treatment at a different hospital or out of India.

  • The treatment costs should not be overly inflated

No law limits the amount a hospital can charge for a certain service. Insurers can safeguard themselves from irrational hospital billing through the reasonable and customary clause. 

They determine fair prices for a treatment based on the range that all hospitals in a given area are charging for that treatment. Then, the insurer will only pay an average price if the hospital bill for the alternative treatment you receive exceeds the amount. The balance amount must be paid out of pocket by you.

What is the AYUSH Ministry?

The term AYUSH is an abbreviation of the complementary medical practices that the Ministry of AYUSH covers: Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy. The Ministry of Health and Family Welfare created the Department of Indian Systems of Medicine and Homeopathy (ISM&H). The Department of AYUSH was formed to replace ISM&H.

In 2014, the Government of India upgraded the department to the status of a formal ministry. Alternative, mainly indigenous forms of medicine were given significant attention in India's subsequent Five-year Plans. The ministry oversees several healthcare initiatives, many of which are concentrated in rural areas. 

Things to remember before buying AYUSH coverage under health insurance

You must consider the following things before opting for AYUSH coverage under your health insurance plan.

  1. There could be a cap on the claim amount for AYUSH treatment. Thus, it is crucial that you review the health insurance policy thoroughly before making a purchase.

  2. Although many health insurance companies now include coverage for AYUSH treatments in their health insurance plans, all insurers may not offer this coverage. If you intend to avail of AYUSH treatment in the future, make sure that you buy a health plan from an insurer that offers this coverage.

  3. A standalone health insurance plan for AYUSH treatment is not available as of now. So, you must buy a regular health insurance policy that offers AYUSH coverage.

  4. Some insurers may include AYUSH coverage in the list of coverages of the policy. However, others may offer this coverage as an add-on. Add-ons are additional coverages that increase the premium of the policy. Be wary of this fact.

  5. Diagnostic tests are not covered for AYUSH treatment under health insurance. So you need to arrange the necessary funds to cover these costs.

  6. At least 24 hours of hospitalisation is necessary to claim AYUSH benefits under a health plan.

Frequently asked questions

Here are some common questions about alternative treatment coverage under health insurance. In case you have more queries, please send an email to [email protected], and our team members will assist you.

Who should choose AYUSH coverage in their health insurance plan?

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The AYUSH cover is available to everyone. However, if you are older than 60, it is advised to get this cover.

Is there a difference between the claim process of AYUSH treatment and allopathic treatment?

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No, there is no major difference between the claim process of AYUSH treatment and allopathic treatment. You must follow the claim process laid down by your health insurance company. You can contact your insurer in case of any doubt.

What is not covered under AYUSH treatment?

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Treatments for rejuvenation or prevention that are not categorised as medical care, pre and post-hospitalisation costs, health check-ups, etc., are not covered by health insurance for AYUSH treatment.

Are all AYUSH treatments covered under health insurance?

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No, your insurance company may not cover all treatments that are a part of AYUSH. Thus, it is crucial that you contact your health insurance provider and check the list of AYUSH treatments covered under the plan.

Is it possible to get a cashless claim for AYUSH treatment?

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Yes, it is possible to get a cashless claim for AYUSH treatment. Simply check if the hospital is a part of your insurer's network; if yes, you can raise a cashless claim. Otherwise, you must pay for the treatment cost and then file for a reimbursement claim.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content, and before making any insurance-related decisions.

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