The Insurance Regulatory and Development Authority of India (IRDAI) recently issued new guidelines directing general and health insurers to extend coverage to treatments under Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) at par with other medical options. This move, to be implemented from April 1, 2024, not only opens up new opportunities, but also presents challenges for the insurance industry.
The IRDAI has required insurers to establish systems that remove existing restrictions and provide cover for AYUSH treatments. The initiative aims to align AYUSH treatments with conventional medical options, recognizing the changing preferences of individuals seeking holistic health solutions. The guidelines include specific criteria for AYUSH hospitals to determine claim eligibility, taking into account factors such as the severity of the condition, treatment details, and possible need for hospitalization.
The challenges
While this directive creates new opportunities for policyholders to access a wider range of health services, challenges lie ahead. Insurers are required to modify existing products with limitations for AYUSH treatments, and concerns have been raised about the complexity of integrating AYUSH into the insurance framework. Challenges include ascertaining the quality of the approximately 80,000 registered AYUSH practitioners in the country, addressing the lack of standardization of treatment procedures and costs, and navigating issues related to product pricing, hospitalization and anti-fraud.
Some insurers are expressing concerns about the tight deadline of April 1, 2024, stating that it is too close for extensive preparation. Despite the challenges, experts acknowledge the significance of extending health insurance to AYUSH treatments, emphasizing the potential to improve accessibility and affordability of quality healthcare.