AYUSH Coverage in Health Insurance: What You Should Know

AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. IRDAI mandates that all health insurance policies cover AYUSH treatments, recognizing the widespread use of alternative medicine in India. Coverage applies to inpatient treatments at government-recognized AYUSH hospitals and centers.

The treatment must require hospitalization, similar to allopathic treatment claims. The sum insured limit for AYUSH treatments is typically the same as the overall policy sum insured, though some plans impose a sub-limit. For a valid AYUSH claim, the treatment facility must be a government hospital or a facility recognized by the relevant AYUSH regulatory body.

The treating practitioner must be a qualified AYUSH professional registered with the appropriate council. The condition being treated must require inpatient care. Documentation requirements are similar to regular health claims including admission records, treatment details, discharge summary, and bills.

Common AYUSH treatments covered include Panchakarma therapy in Ayurveda, acupuncture, homeopathic hospitalization, and Unani inpatient treatments. While AYUSH coverage is mandated, the practical claim experience varies across insurers. Some insurers have a wider network of AYUSH hospitals for cashless claims while others primarily process AYUSH claims on a reimbursement basis.

When choosing a health plan with strong AYUSH coverage, check the number of empaneled AYUSH hospitals, claim settlement history for AYUSH treatments, and whether any sub-limits apply specifically to alternative medicine claims.