Traditional medicine systems like Ayurveda, Yoga, Unani, Siddha, and Homeopathy have long been part of India’s healthcare. However, these treatments were not initially included in health insurance.
In 2013, the Insurance Regulatory and Development Authority of India (IRDAI) allowed AYUSH treatments to be covered under health insurance policies, paving the way for alternative medicine systems to be included.
What Treatments Are Covered?
With this inclusion, policyholders can now claim insurance for both allopathic and AYUSH treatments.
However, there are specific conditions and limits associated with AYUSH coverage that you should be aware of.
Growing Awareness About AYUSH Treatments
A survey by the National Sample Survey Office (NSSO) in 2024 found that 95% of people in rural India and 96% in urban areas are aware of AYUSH systems.
Additionally, 46% of rural and 53% of urban people have used AYUSH treatments in the past year.
The government is also promoting this with initiatives such as including 170 AYUSH packages in the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Efforts are also underway to open traditional medicine stores in every tehsil.
What’s Covered in AYUSH Health Insurance?
Most private insurance companies now offer coverage for AYUSH treatments. This can either be the entire sum insured or a sub-limit within the policy. For instance:
Some policies may cover only a fixed amount for AYUSH treatments, such as ₹25,000, even if the total policy value is ₹5 lakh.
Other policies may cover a percentage of the total sum insured. For example, if the policy covers 10% for AYUSH treatments, you can claim up to ₹50,000 on a ₹5 lakh policy.
It’s important to check your policy for any sub-limits or specific conditions related to AYUSH coverage.
How to Claim for AYUSH Treatment?
To claim insurance for AYUSH treatments, the following conditions apply:
Hospitalization for at least 24 hours is mandatory.
The hospital must be government-recognized and specialize in AYUSH treatment.
Claims for medical exams only or rejuvenation treatments (meant to refresh or re-energize the body) are usually not covered.
Who Can Get AYUSH Health Insurance?
Many private insurers offer AYUSH coverage as a standard policy, an add-on option, or as a separate plan.
The eligibility and coverage depend on the specific terms of the insurance plan.
AYUSH insurance is also available to serving or retired employees under the Central Government Health Scheme (CGHS).
Additionally, state government health schemes like Arogyasri in Andhra Pradesh and Ayushman Bharat in other states also cover AYUSH treatments.
