IRDAI vide Circular Ref. No. IRDAI/HLT/CIR/GDL/31/1/2024 dated January 31, 2024 issued a Guideline on providing AYUSH coverage in Health Insurance Policies.
The major highlights of the Circular are as follows:
1. Board Approved Policy for providing AYUSH coverage: Insurers have been advised to have a Board approved policy for providing AYUSH coverage to be reviewed on an annual basis. The Policy shall include an approach towards placing AYUSH Treatments at par with other treatments, the quality parameters, and the procedure for enrolling AYUSH Hospitals/Day Care Centers as network providers.
2. Modification of Existing Product: Insurers have been advised to modify their existing products that contain limitations for AYUSH Treatments.
3. Controls and SOPs: Insurers have been advised to have adequate controls and Standard Operating Procedures for the following mark:
a. Enrolling hospitals into their network;
b. Placing necessary clauses in their health services agreements with AYUSH Hospitals/Day Care Centres.
c. Standard Treatment Protocols
d. Dealing with the possible frauds and abuse of the system, if any.
4. Engagement with Core Group of Experts for Insurance Sector: The Insurers have been advised to engage actively with the Core Group of Experts for the Insurance Sector constituted by the Ministry of AYUSH, Government of India vide OM No. T.12020/02/2017 – DCC (AYUSH) dated 04.10.2023 and develop required modalities for providing AYUSH Coverage.
Relevant Governing Law:
Rules, Directions, and Recommendations by Ministry of AYUSH, Government of India.
Source category: IRDAI
Attachments
- /2024/343_Ayush_coverage_in_Health_Insurance_Policies.pdf
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