The Insurance Regulatory and Development Authority of India (IRDAI) has issued a circular on January 31, 2024, directing all general and health insurers to provide coverage for AYUSH treatments in their health insurance policies. AYUSH stands for Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy, which are alternative systems of medicine that have gained popularity in recent times.
What is AYUSH Coverage?
AYUSH coverage means that the policyholders can avail cashless or reimbursement facility for AYUSH treatments at par with other treatments. The insurers are required to have a board-approved policy for providing AYUSH coverage, which will include their approach towards placing AYUSH treatments at par with other treatments, the quality parameters for enrolling AYUSH hospitals or day care centers as network providers, and the standard treatment protocols and fraud prevention measures.
Why is AYUSH Coverage Important?
The IRDAI circular states that the move stems from the growing demand for AYUSH treatments, as they have become an established branch of medicine. The circular also mentions that the Ministry of AYUSH has constituted a Core Group of Experts for Insurance Sector to develop modalities for providing AYUSH coverage. The IRDAI expects the insurers to actively engage with this group and comply with their directions.
The benefits of AYUSH coverage are manifold. It will provide the policyholders with more options to choose a treatment of their choice, based on their preferences and beliefs. It will also promote the development and standardization of AYUSH systems of medicine, which have a rich heritage and potential to address various health issues. Moreover, it will increase the accessibility and affordability of AYUSH treatments, which are often cheaper and less invasive than conventional treatments.
How will AYUSH Coverage Impact the Health Insurance Industry?
The IRDAI circular will come into force from April 1, 2024. The insurers are advised to modify their existing products that contain limitations for AYUSH treatments and ensure compliance with the circular. The insurers are also expected to have adequate controls and standard operating procedures for enrolling hospitals into their network, placing necessary clauses in their health services agreements with AYUSH hospitals or day care centers, and dealing with possible frauds and abuse of the system.
The impact of AYUSH coverage on the health insurance industry will depend on various factors, such as the demand and supply of AYUSH services, the pricing and quality of AYUSH treatments, the claim settlement ratio and customer satisfaction of AYUSH policies, and the regulatory framework and guidelines for AYUSH coverage. The insurers will have to balance the benefits of providing more choices to the policyholders with the risks of increasing costs and frauds. The policyholders will have to compare the features and benefits of different health insurance products that offer AYUSH coverage and choose the one that suits their needs and budget.