Introduction: The Insurance Regulatory and Development Authority of India (IRDAI) has released comprehensive guidelines, effective from April 1, 2024, regarding the inclusion of AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatments in health insurance policies. The move acknowledges the increasing popularity and acceptance of AYUSH treatments and aims to provide policyholders with diverse healthcare choices.
Detailed Analysis:
1. Board Approved Policy: Insurers are instructed to develop a Board-approved policy that outlines their approach to integrating AYUSH treatments on par with conventional treatments. This policy must provide policyholders with the option to choose AYUSH treatments and include quality parameters. Additionally, insurers must establish procedures for enrolling AYUSH hospitals and day care centers as network providers for cashless facilities.
2. Product Modification: Insurers are required to modify existing products that limit coverage for AYUSH treatments to align with the new guidelines.
3. Controls and SOPs: Insurers must establish adequate controls and Standard Operating Procedures (SOPs) for enrolling hospitals, incorporating necessary clauses in health services agreements with AYUSH providers, defining standard treatment protocols, and addressing potential fraud and system abuse.
4. Engagement with Core Group: Insurers are urged to actively engage with the Core Group of Experts for the Insurance Sector, as constituted by the Ministry of AYUSH, Government of India. The goal is to collaborate and develop the necessary modalities for providing AYUSH coverage effectively.
5. Effective Date: The circular, issued in accordance with Section 14(2)(b) of the IRDA Act, 1999, will be in force from April 1, 2024.
Conclusion: The IRDAI’s guidelines signify a crucial step in recognizing AYUSH treatments as integral components of health insurance. Insurers need to swiftly adapt to these changes, ensuring that policyholders have the freedom to choose holistic healthcare options. The engagement with the Core Group emphasizes a collaborative approach towards developing modalities for successful AYUSH coverage implementation in the insurance sector. As of April 1, 2024, these guidelines will reshape the landscape of health insurance, providing a more inclusive and diverse range of healthcare choices for policyholders.
Insurance Regulatory and Development Authority
IRDAI/HLT/CIR/GDL/31/01/2024 Dated: 31st January,2024
To
All General and Health Insurers (Except ECGC & AIC)
Sub: Guidelines on providing AYUSH coverage in Health Insurance policies.
In recent times, AYUSH treatments have garnered increased popularity and have become an established branch of medicine. Considering the growing demand for AYUSH treatments, there is a need to consider these treatments at par with other treatments.
Accordingly, all insurers are advised to comply with the following:
1. Insurers shall have a Board approved policy for providing AYUSH coverage, which interalia, shall include their approach towards placing AYUSH Treatments at par with other treatments for the purpose of health insurance so as to provide an option for the policyholders to choose treatment of their choice. The policy shall also contain the quality parameters as well as procedure for enrolling AYUSH Hospitals/Day Care Centers as network providers for the purpose of providing cashless facility.
2. Insurers shall modify their existing products that contain limitations for AYUSH Treatments and ensure compliance with above directions.
3. Insurers shall have adequate controls as well as Standard Operating Procedures(SOP) for –
a. enrolling hospitals into their network;
b. placing necessary clauses in their health services agreements with AYUSH Hospitals/Day Care Centers;
c. standard treatment protocols; and
d. dealing with the possible frauds and abuse of the system, if any.
4. The Insurers shall actively engage with the Core Group of Experts for Insurance Sector constituted by Ministry of AYUSH, Government of India vide OM No. T.12020/02/2017-DCC(AYUSH) dated 04.10.2023 and develop required modalities for providing AYUSH Coverage.
5. This circular will come into force w.e.f 01.04.2024.
This Circular is issued in terms of Section 14(2)(b) of IRDA Act,1999.
A. Ramana Rao
Chief General Manager
