The Insurance Regulatory and Development Authority of India (IRDAI) on January 31, 2024, issued a notification regarding Guidelines on providing AYUSH coverage in Health Insurance policies.
All insurers are advised to comply with the following:
Insurers shall have an approved policy for providing AYUSH coverage, which interalia, shall include their approach towards placing AYUSH Treatments at 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 and the procedure for enrolling AYUSH Hospitals/Day Care Centers as network providers to provide a cashless facility.
Insurers shall modify their existing products that contain limitations for AYUSH Treatments and ensure compliance with the above directions.
Insurers shall have adequate controls as well as Standard Operating Procedures(SOP) for –
a. enrolling hospitals into their network;
b. placing necessary clauses in their health services agreements with AYUSH Hospitals/Day Care Centers;
c. standard treatment protocols; and
d. dealing with the possible frauds and abuse of the system, if any.
This circular will come into force on April 01, 2024.
[Notification No. IRDAI/HLT/CIR/GDL/31/01/2024]
