For centuries, people in India have trusted traditional medicines like Ayurveda, Yoga, Unani, Siddha, and Homeopathy. These methods are part of the AYUSH system, which is deeply rooted in Indian culture. However, until a few years ago, insurance companies did not cover the cost of such treatments.
That changed in 2013 when the Insurance Regulatory and Development Authority of India (IRDAI) officially allowed insurance coverage for AYUSH treatments. Since then, many health insurance companies have included AYUSH coverage in their policies. However, if you want to use this benefit, it is essential to understand the rules and limits and how to claim it.
What Does AYUSH Mean in Health Insurance?
AYUSH stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy. These are traditional and alternative systems of medicine approved by the Ministry of AYUSH, Government of India. These treatments do not follow modern allopathy but are still recognised for healing many health conditions.
Several private and government health insurance schemes offer financial coverage for AYUSH treatments, just like they do for hospitalisation in regular allopathic hospitals.
People Are Choosing AYUSH More Than Ever
According to a 2024 survey by the National Sample Survey Office (NSSO), awareness about AYUSH is very high. Around 95% of rural and 96% of urban Indians know about AYUSH treatment options. Also, 46% of people in rural areas and 53% in urban areas took AYUSH treatment at least once last year.
This shows that traditional medicine is not just a rural idea. Even city people pursue natural healing practices like Ayurveda, Homeopathy, and Yoga.
The central government is also helping AYUSH grow. The Ministry of AYUSH has already included 170 packages in the Ayushman Bharat – PMJAY scheme. They also plan to open AYUSH medicine stores in every tehsil across India.
What Does the Insurance Policy Cover in AYUSH?
Most private health insurance companies now include AYUSH coverage in their regular health plans. Some even offer it as an add-on benefit. The amount of coverage depends on the policy. Here’s how it usually works:
- Full Sum Insured: Some policies cover AYUSH treatment under the full insured amount, just like allopathic treatment. For example, if your health cover is Rs. 5 lakh, you can use the entire amount for AYUSH treatment, if needed.
- Sub-Limit Model: In many cases, insurance companies cap AYUSH claims. For example, if your policy is for Rs. 5 lakh, you might only be allowed to claim up to Rs. 25,000 or Rs. 50,000 for AYUSH treatment.
The limit may be:
- A fixed amount (like Rs. 25,000) or
- A percentage of your total Sum insured (like 10% of Rs. 5 lakh = Rs. 50,000)
Always check your insurance document to know the exact AYUSH cover limit and whether there are any conditions.
When Can You Claim Insurance for AYUSH Treatment?
AYUSH claims are not allowed in every situation. Insurance companies set clear rules to approve the claim. Here are the key points:
- Minimum 24-Hour Hospitalisation Required
- You must be admitted to a recognised AYUSH hospital or institute for at least 24 hours. Day-care or OPD consultations do not count.
- Government Must recognise Hospital
- The treatment must happen in a government-approved or NABH-accredited AYUSH hospital or medical facility. Claims from unregistered places will not be accepted.
- Only Curative Treatment is Covered
- The insurance will not cover wellness therapies or rejuvenation treatments like Panchakarma, detox, or spa-type services. Only treatments for a specific medical condition are considered.
How to Make a Claim for AYUSH Treatment?
Claiming insurance for AYUSH treatment works similarly to regular hospitalisation claims. Here’s what to do:
- Inform the Insurance Company: Always inform the insurer before admission if possible.
- Submit Valid Documents: You must submit all hospital bills, doctor’s prescriptions, admission/discharge summaries, and treatment details.
- Choose Between Cashless or Reimbursement: If your insurer has tie-ups with AYUSH hospitals, you may get cashless treatment. Otherwise, pay the bill and file for reimbursement later.
- Keep an Eye on Claim Limits: If your policy has a Rs. 50,000 cap for AYUSH, and your bill is Rs. 70,000, you can only get Rs. 50,000 reimbursed.
Who Can Buy AYUSH Health Insurance?
Almost anyone can buy a health policy that includes AYUSH coverage. You can get it:
- As part of Standard Health Insurance: Many plans from Star Health, HDFC ERGO, Niva Bupa, and others include AYUSH benefits.
- As an Add-On: If your current policy doesn’t have AYUSH, some insurers let you add it for a small fee.
- As a Separate Policy: Few insurers offer special standalone policies for AYUSH treatments.
- Through Government Schemes:
- Central Government Health Scheme (CGHS) also covers AYUSH for government employees and pensioners.
- State schemes like Arogyasree (Andhra Pradesh) and Ayushman Bharat cover AYUSH for eligible families.
Things to Keep in Mind Before Choosing AYUSH Cover
- Check Network Hospitals: Not all AYUSH hospitals are covered under cashless networks. Choose policies that have good hospital coverage near you.
- Understand Sub-Limits: Don’t assume full policy cover is available for AYUSH. Many plans have caps or restrictions.
- Read Policy Documents: Each policy is different. Read the terms and conditions to know exactly what is allowed.
- Compare Plans: Before buying, compare the policies of different insurers to see who gives better AYUSH coverage for the premium charged.
Why AYUSH in Health Insurance Is a Big Step
Including AYUSH in health insurance significantly changes India’s health system. It supports people who trust natural and traditional ways of healing. It also makes such treatments affordable for families who had to pay out of their pocket earlier.
Whether you prefer Ayurveda for joint pain, Homeopathy for chronic conditions, or Yoga for stress relief, insurance support can help you access quality treatment without financial stress.
So, if you plan to buy a new health policy or want to renew your old one, check if AYUSH coverage is included. It is the proper support you need for natural healing.
Sources:
Ministry of AYUSH, IRDAI, NSSO Survey 2024, Ayushman Bharat PMJAY, HDFC ERGO, Star Health
Disclaimer:
This article is for informational purposes only. Please refer to your insurance provider’s policy documents for the latest and specific terms related to AYUSH coverage.
