Posted by Many people prefer traditional, alternative treatments to modern, western ones, especially in India. Ayurveda, Unani, Siddha, homeopathy, naturopathy, and other alternative therapies, also referred to as AYUSH therapies, are among them. Since they have few to no side effects and are quite successful, many people believe that these alternative treatments are safer. Look below to know alternative treatments covered under health insurance.
Conditions For Coverage Of Alternative Treatments
1)Place Of Treatment
The alternative treatment you’re undergoing should be in India -in a central or state government AYUSH hospital. If you undergo the treatment in another hospital or outside India, the insurance company won’t cover the expenses.
2) Medically Necessary And Prescribed In Writing
If the treating physician specifies the alternative treatment in writing and determines it to be medically necessary, the insurance provider will only cover its costs.
A procedure is considered medically necessary if:
Is necessary for the treatment of the sickness or harm sustained.
Does not go beyond what is required in terms of breadth, length, or intensity to deliver safe, adequate, and appropriate medical care.
Is suggested by a doctor who is not a relative of yours.
Complies with industry standards widely accepted by the Indian medical community or in international medical practice.
3)Reasonable And Customary Clause
No law limits the amount a hospital can charge for a certain service in India. They occasionally price differently for the same therapy depending on who you are, especially if they discover you have insurance. Insurance companies have reasonable and customary clauses at their disposal to defend themselves against such irrational hospital billing.
Insurers determine the fair and customary prices for therapy based on the acceptable range of payment that all hospitals in a given area are charging for that treatment. Therefore, the insurer will only pay the reasonable and customary amount if the cost of the alternative therapy you are receiving exceeds that amount. The remaining hospital charge must be paid out of pocket by you.
Alternative Treatments Coverage Limitations
Alternative treatment coverage varies from policy to policy and from insurer to insurer in terms of its extent.
1)Coverage Upto A Certain Amount
A few health insurance programs offer partial coverage for complementary therapies. For instance, even though you have a health insurance policy worth INR 20 lakhs, only INR 50,000 will be reimbursed for alternative treatments.
2)Coverage Up To the Sum Insured
Some policies offer protection up to the amount of insurance you’ve chosen. For instance, the insurance provider will pay the full INR 10 lakhs if you purchase coverage worth INR 10 lakhs and receive an alternative treatment costing INR 10 lakhs. Plans that pay for alternative treatments up to the policy sum insured include Max Bupa Health Companion, Manipal Cigna Prohealth, Niva Bupa Health Reassure, ICICI Lombard Complete Health Insurance, National Insurance Mediclaim Plus Policy, etc.
Different Coverage For Different Hospitals
The maximum amount of coverage for care in a government hospital varies from other hospitals in some health insurance policies. For instance, if you are admitted to a government hospital, the Royal Sundaram Lifeline Policy will cover alternative therapies up to the base sum insured and up to INR 30,000 for other hospitals.
Not All Ayush Treatments Are Covered
Some health insurance plans do not pay for all AYUSH procedures. For instance, yoga/naturopathy treatments are not covered by Star Health Comprehensive Policy or Niva Bupa Reassure.
OPD Expenses Not Covered
Some insurance plans do not cover OPD costs, which are costs incurred when you receive treatment outside of a hospital setting, such as in or near a doctor’s office or emergency room.