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Health Insurance Approved Ayurveda Medical Care

Ayurveda medical care is available to you on cashless or reimbursement basis at AyurVAID Hospitals, supported by all leading health insurance companies and Third Party Administrators (TPAs).

Insurance companies

Health Insurance Approved Ayurveda Medical Care

We are proud to declare that for many of our insurance partners, AyurVAID is the first and only Ayurveda hospital chain on their nationwide accredited hospitals network. With AyurVAID Hospitals also being registered under the Government of India’s Registry of Hospitals in Network of Insurance (ROHINI) as per the Insurance Regulatory and Development Authority (IRDA) guidelines, AyurVAID Hospitals’ Ayurveda treatment gets covered in the health insurance policy under the clause relating to AYUSH or Alternative Medicine coverage.

Starting 1st January 2020, the Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory that for any new insurance products to be launched by insurance companies effective October 2020 to receive IRDAI approval, they should include coverage for Ayurveda/Ayush in-patient medical care1. However, when you buy a new insurance policy or renew an earlier one, it may be based on an earlier IRDAI-approved insurance product and may or may not have Ayush coverage. Thus, it is important for you to insist on Ayurveda/Ayush coverage up to the full sum covered without unreasonable restrictions/ sub-limits, etc. being imposed on you.

However, if your medical needs are covered by the company you work for under a corporate health insurance scheme, you may contact your HR Manager or Employee Benefits Manager OR the insurance company/TPA representative who services your insurance policy and seek clarification.

If you are still not sure, please contact us, and we will be happy to support you to ascertain if Ayurveda care is covered under your policy and if there are attendant special terms and conditions if any.

Please also refer to the FAQs below to receive answers to any questions that remain.

Insurance TPAs

FAQ on Health Insurance for Ayurveda

Which insurance companies cover Ayurveda/Ayush treatments under their policies?
The Insurance Regulatory and Development Authority of India (IRDAI) has provided the Ministry of Ayush1 with a list of the following 15 General Insurance Companies and Standalone Health Insurance companies that are offering products covering one or more systems of AYUSH treatment:

(i) New India Assurance Co. Ltd.
(ii) Oriental Insurance Co. Ltd.
(iii) United India Insurance Co. Ltd.
(iv) National Insurance Co. Ltd.
(v) Tata AIG General Insurance Co. Ltd.
(vi) Bharati AXA General Insurance Co. Ltd.
(vii) Liberty Videocon General Insurance Co. Ltd.
(viii) Reliance General Insurance Co. Ltd.
(ix) Bajaj Allianz General Insurance Co. Ltd.
(x) Universal Sompo General Insurance Co. Ltd.
(xi) Magma HDI General Insurance Co. Ltd.
(xii) HDFC Ergo General Insurance Co. Ltd.
(xiii) Apollo Munich Health Insurance Co. Ltd. (now part of HDFC Ergo)
(xiv) Star Health Allied insurance Co. Ltd.
(xv) CIGNA TTK Health Insurance Co. Ltd.

It may be noted that the above list is prone to change at any time since there are a large number of insurance companies today launching new products on a regular basis. Suffice it to say that there are a large number of well-established health insurance companies that now include Ayurveda in-patient medical care under the scope of coverage of their insurance products.
How do I know if a specific centre of AyurVAID Hospitals is empanelled by my insurance company or TPA?
AyurVAID’s standalone hospitals at Bangalore, Kochi, and Almora are empanelled with most leading insurance companies and TPAs for cashless/reimbursement treatment subject to terms and conditions of insurance policies issued by different companies. In addition, for our hospitals located within leading hospitals such as Medanta Medicity, Aster Medcity, Aster CMI, and Sri Shankara Cancer Care Hospitals, we will be able to apply similarly for insurance coverage for Ayurveda in-patient medical care.

Please refer to the website of your insurance company or your TPA for the approved network hospital list or the booklet that has been given to you when you purchased your health insurance policy and received a membership kit. If a particular AyurVAID hospital facility is empanelled, it will be listed in alphabetic order under the State and City that you are searching for. In the event our name is not listed, it will imply that this specific centre is not empanelled with this particular insurance company or TPA. We will try nonetheless for cashless approval, but it will be at the discretion of the insurance company/TPA to accord or deny approval.
What are the key points I need to look out for in my health insurance policy document?
i. Is Ayurveda/Ayush treatment covered under your policy?
ii. Are there any sub-limits or restrictions on scope of Ayurveda/Ayush coverage?
iii. Is cashless facility available or reimbursement or both?
iv. Any waiting period for specific medical conditions? i.e. whether the medical condition for which you are seeking treatment is excluded under a waiting period starting from 1 year and going up to 4 years?
v. Coverage for pre-existing conditions and whether the condition that you are seeking treatment for is included in this list of pre-existing diseases that are excluded?
vi. Requirements for the treatment facility (NABH/Quality Council of India accreditation/ local government approval/ government medical college, etc.)

It may be noted that vide
https://cdn.ayush.gov.in/wp-content/uploads/2021/03/Circular-dated-10-Jan-2017.pdf, the IRDAI has advised insurance companies that they may extend coverage for Ayurveda/Ayush treatment provided the treatment is provided in an Ayurveda hospital having registration with relevant State Government authority and which complies with following minimum criteria:

a. Has at least 15 in-patient beds
b. Has minimum 5 qualified and registered Ayurveda doctors
c. Has qualified paramedical staff under its employment round the clock
d. Has dedicated Ayurveda/Ayush therapy sections
e. Maintains daily records of patients
How can AyurVAID help me with insurance related documentation?
Our hospital team will provide you with all the required guidance and supporting documents throughout the insurance claim cycle.

If you are entitled for cashless coverage, at or immediately prior to the time of planned admission, the pre-authorisation form will be duly filled and sent to the insurance company for approval, backed by a physician’s summary justifying the need for in-patient medical care with all supporting clinical facts and reports. One or more rounds of queries from the insurance company/TPA shall be promptly responded to until a definite approval or denial is received. Upon completion of treatment, our insurance team will ensure that all documents for submission are accurate and complete so that you may leave the hospital on time, without hindrance, and with minimal inconvenience.

If you are entitled to or prefer to avail of treatment on a reimbursement basis, then upon conclusion of treatment we will provide you with all necessary medical and commercial documentation to submit a valid claim. Our hospital team will also guide you on the process and timelines to be adhered to in this regard.
While my policy clearly states that Ayurveda is covered on cashless basis, can the TPA deny cashless and ask me to go on reimbursement basis?
If your policy explicitly states that Ayurveda treatment is covered on cashless basis, the insurance company or TPA is obliged to provide that service to you. It may however be that the insurance company or TPA need certain additional information on the clinical/medical justification for in-patient admission and/or they have some doubt if your medical condition comes under the purview of a pre-existing condition or an excluded condition under the policy terms and conditions. In the latter case, if the medical condition for which treatment is sought is excluded from scope of coverage, then the insurance company will be within its rights to deny. However, we will provide you with the necessary information and medical assessment summary to enable you to clarify the insurance company or TPA’s doubts to the fullest extent and to exercise your rights to Ayurveda treatment if provided for under your policy.
Are 100% of my hospitalisation expenses covered under insurance for reimbursement?
Most insurance policies have a list of expenses/charges that are disallowed under either cashless or reimbursement claims. These include specified non-medical expenses, specified administrative or non-medical charges, external durable devices, specified consumables etc. This is in accordance with IRDAI guidelines and may be referred as listed at Annexure I of the following IRDAI notification: https://www.irdai.gov.in/admincms/cms/Uploadedfiles/NEWINDIA15/Universal%20Health%20Insurance%20 Policy%20(APL).pdf
Please refer your personal health insurance policy and the detailed terms and conditions listed in annexure thereto wherein the list of disallowable expenses under your policy will be clearly specified.
Are Ayurveda outpatient treatments covered under insurance?
No. A minimum of 24-hours hospitalization is mandatory to avail of insurance coverage for Ayurveda medical management. However, a mix of outpatient and inpatient medical care may be covered by your insurance policy subject to the minimum 24 hour stipulation and also if the plan of care as per treating doctor’s summary clearly establishes justification for medical management on inpatient basis.

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