Are Alternative Treatments Covered Under Health Insurance?

Many people, especially in India, prefer traditional, alternative treatments over conventional, western treatments. Alternative treatments, also known as AYUSH treatments, include Ayurveda, Unani, Siddha, Homoeopathy, Naturopathy, etc. A lot of people find such alternative treatments safer as they have minimal or no side effects and are highly effective. 

Alternative treatments also don’t cost much. But are the expense of such alternate and ayurvedic treatment covered in health insurance? 

Let’s find out. 

Do Health Insurance Policies Cover Alternative Treatments?

Yes, there are some policies in the market that cover costs incurred while undergoing alternative treatments. These expenses are covered under the ‘alternative treatment benefit’ under a health insurance policy. 

For alternative treatment expenses to be covered under health insurance, there are a few conditions that need to be met. Let’s learn about these conditions in detail.

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 & Prescribed in Writing

The insurance company will only pay for the alternate treatment if it is prescribed by the treating doctor in writing and is medically necessary. 

A treatment is said to be medically necessary if it - 

• Is required for the medical management of the illness or injury suffered. 
• Does not exceed the level of care essential to provide safe, adequate, and appropriate medical care in scope, duration, or intensity.
• Is recommended by a medical practitioner who is not related to you. 
• Conforms to professional standards widely accepted in international medical practice or by the Indian medical community.

3 - Reasonable and Customary Clause

In India, there is no regulation that places a cap on how much a hospital can charge for a particular service. They sometimes charge differently from different people for the same treatment - especially when they find out you have insurance. Insurers can protect themselves against such unreasonable hospital billing with the reasonable and customary clause. 

Insurers look at the acceptable range of payment for a specific treatment that all hospitals in a given area are charging and then decide the reasonable and customary charges for that treatment. So, if the cost of the alternative treatment you’re undergoing is more than the reasonable and customary charge, the insurer will only pay the reasonable and customary amount. You’ll have to pay the remaining hospitalization bill from your pocket. 

Please note: These conditions may vary across insurance companies. So, ensure you go through your policy document before you opt for this benefit.

Alternative Treatments Coverage Limitations

The scope of coverage of alternative treatments differs from insurer to insurer and policy to policy too. Let’s learn how.

Coverage up to a certain amount

A few health insurance plans cover alternative treatments up to a certain amount. For instance, you’ve taken a health insurance policy of INR 20 lakhs, but alternative treatments will only be covered up to INR 50,000. 

Coverage up to sum insured

Some plans provide coverage up to the sum insured you’ve chosen. For instance, if you buy a policy of INR 10 lakhs and undergo an alternative treatment for INR 10 lakhs, the insurance company will cover the entire INR 10 lakhs.

Max Bupa Health Companion, Manipal Cigna Prohealth, Niva Bupa Health Reassure, ICICI Lombard Complete Health Insurance, National Insurance Mediclaim Plus Policy, etc. are a few plans that cover the expenses of alternative treatments up to the policy sum insured.

Different coverage for different hospitals

In some health insurance policies, the maximum coverage for treatment in a government hospital differs from other hospitals. For instance, the Royal Sundaram Lifeline Policy will cover alternative treatments up to the base sum insured if admitted to a government hospital and up to INR 30,000 for other hospitals.

Not all AYUSH treatments covered

There are health insurance policies that do not cover all AYUSH treatments. For instance, Star Health Comprehensive Policy and Niva Bupa Reassure do not cover treatments taken under yoga/naturopathy.

OPD expenses not covered

Some insurance policies do not cover OPD expenses i.e. expenses incurred when the treatment doesn’t require you to get admitted to a hospital - the treatment is carried out in or around 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. 

Please note: The above limits and conditions may vary across insurance companies. So, ensure you go through your policy document before you opt for this benefit.

If you have any further questions related to insurance coverage for alternative medicine, you can post them on the Beshak Insurance Forum and get answers from insurance experts.