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IRDAI asks general insurers to include traditional medical treatment in coverage

The IRDAI has directed general insurers to place traditional medical treatment on par with other medical treatments in health insurance policies. Insurers have to comply with the directive with effect from 1 April 2024.

The insurance regulator says in a circular that in recent times, AYUSH treatments have garnered increased popularity and have become an established branch of medicine. AYUSH stands for Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy.Accordingly, all insurers are advised to comply with the following:

1. Insurers shall have a board-approved policy for providing AYUSH coverage, which inter alia, shall include their approach towards placing AYUSH treatments on par with other treatments for health insurance to provide an option for the policyholders to choose the treatment of their choice.

The policy shall also contain the quality parameters as well as the procedure for enrolling AYUSH hospitals/daycare centres as network providers for the purpose of providing a cashless facility.

2. Insurers shall modify their existing products that contain limitations for AYUSH treatments and ensure compliance.

3. Insurers shall have adequate controls as well as standard operating procedures for –

  • enrolling hospitals into their network;
  • placing necessary clauses in their health services agreements with AYUSH hospitals/daycare centres;
  • standard treatment protocols; and
  • dealing with the possible frauds and abuse of the system, if any.

4. Insurers shall actively engage with the Core Group of Experts for the Insurance Sector constituted by the Ministry of AYUSH and develop the required modalities for providing AYUSH coverage. Asia Insurance Review

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