IRDAI brings AYUSH under health cover from April 2024

Insurance Regulatory and Development Authority of India(IRDAI) directs general, health insurers to frame policy for AYUSH coverage

Under the new guidelines, effective from April 1, 2024, IRDAI has directed all general and health insurers (except ECGC and AIC) to put in place a board-approved policy for AYUSH coverage, which should include their approach towards placing AYUSH treatments on par with other treatments for health insurance coverage, thereby allowing policyholders to adopt a treatment of their choice.

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

“Insurers shall modify their existing products that contain limitations for AYUSH treatments and ensure compliance with above directions,’‘ the regulator said.

The insurers should have adequate controls as well as standard operating procedures (SOP) for enrolling hospitals into their network, placing clauses in their health services agreements with AYUSH hospitals/daycare centres, and standard treatment protocols, according to the guidelines.

Apart from dealing with possible frauds and abuse of the system, if any, the insurers should ‘actively’ engage with the Core Group of Experts for the Insurance Sector constituted by the Ministry of AYUSH, the insurance regulator said.

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