Insurance regulator IRDAI has recently issued directions to all insurance companies telling them to cover AYUSH treatment just as other treatments. AYUSH refers to the treatment given under alternative therapies of Ayurveda, Yoga, Unani, Siddha and Homeopathy.
The latest move stems from the growing prevalence of these treatments, because of which the regulator felt the need to consider these treatments at par with other treatments for the purpose of health insurance.
The IRDAI circular says, “the insurance companies will have a board approved policy for providing AYUSH coverage which will 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 will also contain the quality parameters as well as procedure for enrolling AYUSH hospitals/ day care centres as network providers for the purpose of providing cashless facilities,” the circular adds.
The circular further says that the insurers will have adequate controls as well as standard operating procedures for a number of activities which include the following:
1. Enrolling hospitals into their network.
2 Placing necessary clauses in their health services agreements with Ayush hospitals/ day care centres.
3. Standard treatment protocols, and
4. Dealing with the possible frauds and abuse of the system, if any
For this purpose, the Ministry of Ayush on Oct 4, 2023 constituted a ‘Core Group of Experts for Insurance Sector’.
The insurance companies are told to actively engage with this group in order to develop required modalities for providing Ayush coverage.
The directions issued on Jan 31 will come into effect from April 1, 2024.
High premiums
Meanwhile, in another news IRDAI chief flagged the concern of high premium and highlighted the need for individual risk profiling. IRDAI Chief Debasish Panda said data analytics should ensure that premiums take into account the individual risk and not the average risk of the group.
“There is a need to build an ecosystem where premiums are no longer one-size-fits all but are customised to individual risk profiling,” he said.
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Published: 02 Feb 2024, 03:09 PM IST