Money & Banking

Health cover soon for outpatient Ayush treatment

Deepa Nair PT Jyothi Datta Mumbai | Updated on January 20, 2018 Published on May 22, 2016

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With push from the Centre, insurers are drawing up new packages





Health insurance for alternative treatments such as Ayurveda, Yoga, Unani, Siddha and Homoeopathy (Ayush) is set to expand with the Centre taking steps to get insurers to develop packages for traditional treatments.

A handful of PSU and private health insurance companies have made a commitment to the Centre to draw up packages for Ayush treatments, a source familiar with the development told BusinessLine.

The companies said to be involved in the exercise include New India Assurance, National Insurance, Universal Sompo, Star Health Insurance, Max Bupa, Apollo Munich and Oriental Insurance.

Ayush practitioners have for long complained about insurers not covering alternative outpatient treatment. Towards Ayush

The Ayush Ministry is working with the National Accreditation Board for Hospitals and Healthcare Providers (NABH) to streamline guidelines for different traditional treatments.

“Only when companies come out with packages can further interventions be made to expand insurance cover to outpatient treatments (that does not involve hospitalisation),” said the government source. 

The reason why health insurance for Ayush has not taken off is that it covers only hospitalisation, when traditional treatments are in fact often done in outpatient departments.

Sanjay Datta, Chief (Underwriting - Claims and Reinsurance), ICICI Lombard, agreed that clearer regulations will see insurers offering cashless services across Ayush hospitals (currently insurers do not include them in their preferred provider network).

This will further boost customer demand for Ayush treatments, he added.

Select products

“Health covers for Ayush treatments have not become mainstream and even what is offered by most insurers is only on select health insurance products,” said Segar Sampathkumar, General Manager, New India Assurance. Presently, Ayush coverage is bundled with a comprehensive health insurance plan, and comes at a higher premium.

A 30-year-old taking Bajaj Allianz’s Health Care Supreme cover for ₹5 lakh will pay ₹10,300 as premium for a comprehensive insurance plan with Ayush treatments.

So, a patient hospitalised in a recognized Ayurveda hospital with knee-joint pain will be covered for the regular room rent, nursing, consultation, medicines etc and Ayurvedic treatment procedure charges.

The same customer’s premium would be 5-10 per cent less in a regular health plan without Ayush and other outpatient benefits.

“Cancer patients often opt for Ayush treatments. In some cases, allopathic treatment continues with traditional postoperative procedures,” explained an insurance expert. “A person paralysed by a brain stroke may be advised follow-up with Ayurvedic procedures, and this is reimbursed,” she added.

There is little historical data on outcomes, but there are clear pathways on treatment and medicines, she said.

And, while treatments at the Kotakal Arya Vaidya Sala are reimbursed, Unani and Siddha are largely limited to outpatient treatment in government centres.

Stumbling blocks

The Insurance Regulatory and Development Authority of India had, in 2013, asked insurers to cover Ayush treatments, without making it mandatory.

Health insurance payments were given only to those treated in government hospitals or institutions accredited by the Quality Council of India or NABH. With only hospitalisation covered and treatment guidelines unclear for traditional treatments, the initiative did not take off.

Rajiv Kumar, Universal Sompo General Insurance’s Head of Operations and Corporate Planning, said the number of government-run Ayush hospitals is limited and those providing in-patient facilities are fewer.

But that too is changing, as hospitals like Medanta and the new AIIMS (All India Institute of Medical Sciences) offer, or are slated to do so, integrated holistic treatments.

Additionally, the Centre has promised an AIIMS-like Ayurveda hospital. 

Published on May 22, 2016
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