IRDAI mandates AYUSH options in health covers from April 1 

February 02, 2024 08:49 pm | Updated 08:49 pm IST - HYDERABAD

Insurance regulator IRDAI has set April 1 as deadline for insurers to include AYUSH treatment under health covers.

Given their popularity and a growing demand, there is a need for AYUSH treatments to be considered on a par with others, the Insurance Regulatory and Development Authority of India has advised general and health insurers. AYUSH refers to Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines.

In a circular prescribing the guidelines, Chief General Manager A. Ramana Rao said the regulator wanted the insurers to have a board approved policy on AYUSH coverage to enable policyholders to choose a treatment of their choice. The policy ought to contain the quality parameters as well as procedure for enrolling AYUSH hospitals/day care centres as network providers for the purpose of providing cashless facility.

Separately, it stressed the need for insurers to have adequate controls as well as standard operating procedures (SOP) with regard to enrolling hospitals, necessary clauses in health services agreements with the facilities, standard treatment protocols as well as dealing with possible frauds and abuse of the system, if any.

“Insurers shall modify their existing products that contain limitations for AYUSH treatments and ensure compliance with the directions,” IRDAI said. The regulator also wanted the insurance companies to actively engage with the Core Group of Experts for Insurance Sector constituted by Union Ministry of AYUSH and develop required modalities for providing the coverage. The circular comes into effect on April 1, 2024.

In December 2023, the Madurai Bench of the Madras High Court had issued directions to IRDAI to place AYUSH treatment on a par with allopathic treatment and direct the insurance companies to reimburse on equal scales.

In another communication, IRDAI said a February 2023 circular on insurance cover for persons with disabilities (PWD), persons with HIV/AIDS, and those suffering from mental illness, was being modified to include “expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines is covered up to 100% of sum insured, during each policy year as specified in the policy schedule.” The modification will take effect on April 1.

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