Coverage Of Alternative Treatments Under Health Insurance

Alternative treatments are treatments that don’t fall under the umbrella of conventional western medicine. These are also known as AYUSH treatments and include Ayurveda, Unani, Siddha, Homoeopathy, Naturopathy, etc. alternative treatments are considered safer, cheaper and more effective by many.

But, does health insurance cover alternative treatments? Let's find out.

Does Health Insurance Cover Alternative Treatments?

Yes, some policies in the Indian market cover alternative treatments - under the 'alternative treatment benefit' in a health insurance policy.

For alternative treatments to be covered under health insurance, certain conditions must be met. Let's have a look.

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Conditions For Coverage Of Alternative Treatments

The conditions associated with the alternative treatment coverage may vary from insurer to insurer. Make sure you go through and understand the same.

  • Treatment Location

    Policies may require you to undergo treatment in a central or state government AYUSH approved hospital situated in India. If you wish to get treated in any other hospitals, the costs may not be covered by the policy.

  • Medically Necessary & Prescribed In Writing

    The treatment must be medically prescribed by a certified doctor in writing and it must be deemed necessary. In order for a treatment to be considered medically necessary, it must meet the following criteria -

    The treatment must be required for medical management of the illness or injury.

    Any treatment provided should not exceed the level of care essential to provide safe, adequate, and appropriate medical care in scope, duration, and intensity.

    There should be no relationship between you and the medical practitioner who recommended the treatment.

    The treatment should adhere to professional norms universally acknowledged in international medical practice or by Indian medical communities.

  • Reasonable And Customary Clause

    Hospitals in India are not bound by any rules regarding how much they can charge for particular services. It is not uncommon to find hospitals that charge differently for the same treatment - depending on their locality, the people they cater to, whether you have insurance, etc.

    So, insurers protect themselves against such situations with the reasonable and customary clause.

    In order to cover a specific treatment, the insurer shall first check the charges imposed by hospitals in a particular area, and then determine the reasonable and customary charges. If your hospital charges more than the reasonable and customary amount for your alternative treatment, your insurer will only pay the reasonable and customary amount, and you will be responsible for the remaining hospitalisation bill.

Limitations Of Alternative Treatments Coverage

The extent of coverage for alternative treatments differs across insurers and products -

Coverage May Have Financial Limits

Certain companies provide coverage on alternative treatment upto the sum insured. For instance, if you have a health insurance policy of Rs 15 lakhs and undergo an alternative treatment for Rs 15 lakhs, the insurance company may cover the entire treatment expenses of Rs 15 lakhs.

Health Insurance plans such as Max Bupa Health Companion, Manipal Cigna Prohealth, Niva Bupa Health Reassure, ICICI Lombard Complete Health Insurance, National Insurance Mediclaim Plus Policy, etc., cover alternative treatments up to the policy sum insured.

However, not all insurance companies cover alternative treatments up to the sum insured. Some may have a sub-limit, which is a percentage of the sum insured or a certain financial limit in the policy.

Some AYUSH Treatments Are Not Covered

Some health insurance policies do not cover certain AYUSH treatments.For example plans like Star Health Comprehensive policy and Max Bupa ReAssure plan have explicitly mentioned that any expenses incurred on treatment taken under Yoga/Naturopathy will not be covered.

OPD Expenses Are Not Covered

OPD treatments under alternative treatments may not be covered under health insurance. They do not require hospitalisation and are usually carried out in the doctor’s room or the emergency room.

For instance, the Health-Guard plan by Bajaj Allianz doesn't cover OPD expenses for alternative treatments.

Coverage Varies For Different Hospitals

Some health insurance offers different coverage for different hospitals. This means that the maximum level of coverage you receive for treatment in a government hospital shall be different compared to other hospitals.

For instance, Raj has purchased a health insurance policy with a cover amount of Rs 5 Lakhs. His policy covers alternative treatments up to the base sum insured in case he gets treated in a government hospital and up to Rs 30,000 for other hospitals. He undergoes Ayurvedic treatment for joint pain in a private hospital. The treatment cost comes up to Rs 40,000. The policy shall pay him Rs 30,000 and the remaining Rs 10,000 must be paid by him.

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Summing Up!

Aternative treatment or allopathy, no matter your choice, health insurance promises to hold your hand throughout your healing journey – protecting your financial well-being. The limitations and conditions mentioned in this article may vary across insurers. Make sure you read your policy documents before opting for this benefit.

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