What is the story about?
Health insurance coverage for Ayush treatments has formally moved closer to parity with modern medicine in recent years, but practical challenges in claim approvals and reimbursement continue to remain, according to Rajiv Vasudevan, founder and managing director of Apollo AyurVAID.
Vasudevan said regulatory changes by the Insurance Regulatory and Development Authority of India (IRDAI) have sought to remove differences between coverage for modern medicine and traditional systems such as Ayurveda.
According to him, a notification issued in January 2024 required that new health insurance policies issued from October that year should not differentiate between Ayush treatments and modern medical care in terms of coverage.
He also referred to the regulator’s “cashless everywhere” initiative introduced from April 1, 2024, under which policyholders can seek cashless treatment at hospitals beyond insurer networks.
The framework, he said, also extends to Ayush hospitals.
“On paper, there is no difference between Ayush coverage and modern medicine coverage,” Vasudevan said, referring to the regulatory intent.
Claims process may still face delays
Despite the regulatory push, Vasudevan said that in practice patients seeking coverage for Ayush treatments may encounter hurdles in the claims process.
He said insurers can raise repeated queries or delay approvals, even though the cashless framework requires responses within a specified time window. According to him, this can result in a significant share of claims not being processed despite being valid.
“One way to restrict access is by repeated queries or delays in approval,” he said, adding that patients may sometimes find their applications not accepted even when documentation is provided.
Another issue relates to the perception that Ayush treatments are largely outpatient in nature, which can lead insurers to question the need for hospitalisation in some cases, he said.
Hospitalisation requirement often questioned
Vasudevan said that insurers sometimes challenge whether hospital admission is necessary for certain conditions treated under Ayurveda.
He cited examples such as advanced neurological disorders, chronic autoimmune conditions and rehabilitation cases where hospital-based treatment may be recommended in Ayurveda but could face scrutiny from insurers.
For instance, patients recovering from events such as stroke may require extended rehabilitation lasting several weeks or months, but insurance coverage is typically focused on the acute hospitalisation period, he said.
“The person may need rehabilitation for one or two months, but once the acute care phase is over, they are discharged and the rehabilitation phase is largely left to the family,” Vasudevan said.
Coverage varies more by insurer than by state
According to him, differences in access to Ayush insurance coverage are not strongly linked to geography but rather to individual insurers and policy terms.
“The uniformity depends on the policy the customer has. Some companies may be more open while others may deny more often,” he said.
Government-backed schemes and institutional health systems such as Central Government Health Scheme (CGHS) and Ex‑Servicemen Contributory Health Scheme (ECHS) have increasingly incorporated Ayush treatments in their coverage frameworks, he noted.
Small share of claims
Vasudevan said claims related to Ayush treatments still represent a relatively small share of overall health insurance claims. As a result, insurers may not prioritise building deeper expertise around these therapies.
“Ayush claims are still a small fraction of the total claims. From a business standpoint, insurers may not devote too much energy to it,” he said.
However, he added that demand for such treatments appears to be rising, particularly among younger, urban and digitally aware consumers who are exploring alternative and integrative care options.
As the number of accredited Ayush hospitals grows and regulatory support increases, he said the role of insurance coverage in the segment could expand further over time.
Vasudevan said regulatory changes by the Insurance Regulatory and Development Authority of India (IRDAI) have sought to remove differences between coverage for modern medicine and traditional systems such as Ayurveda.
According to him, a notification issued in January 2024 required that new health insurance policies issued from October that year should not differentiate between Ayush treatments and modern medical care in terms of coverage.
He also referred to the regulator’s “cashless everywhere” initiative introduced from April 1, 2024, under which policyholders can seek cashless treatment at hospitals beyond insurer networks.
The framework, he said, also extends to Ayush hospitals.
“On paper, there is no difference between Ayush coverage and modern medicine coverage,” Vasudevan said, referring to the regulatory intent.
Claims process may still face delays
Despite the regulatory push, Vasudevan said that in practice patients seeking coverage for Ayush treatments may encounter hurdles in the claims process.
He said insurers can raise repeated queries or delay approvals, even though the cashless framework requires responses within a specified time window. According to him, this can result in a significant share of claims not being processed despite being valid.
“One way to restrict access is by repeated queries or delays in approval,” he said, adding that patients may sometimes find their applications not accepted even when documentation is provided.
Another issue relates to the perception that Ayush treatments are largely outpatient in nature, which can lead insurers to question the need for hospitalisation in some cases, he said.
Hospitalisation requirement often questioned
Vasudevan said that insurers sometimes challenge whether hospital admission is necessary for certain conditions treated under Ayurveda.
He cited examples such as advanced neurological disorders, chronic autoimmune conditions and rehabilitation cases where hospital-based treatment may be recommended in Ayurveda but could face scrutiny from insurers.
For instance, patients recovering from events such as stroke may require extended rehabilitation lasting several weeks or months, but insurance coverage is typically focused on the acute hospitalisation period, he said.
“The person may need rehabilitation for one or two months, but once the acute care phase is over, they are discharged and the rehabilitation phase is largely left to the family,” Vasudevan said.
Coverage varies more by insurer than by state
According to him, differences in access to Ayush insurance coverage are not strongly linked to geography but rather to individual insurers and policy terms.
“The uniformity depends on the policy the customer has. Some companies may be more open while others may deny more often,” he said.
Government-backed schemes and institutional health systems such as Central Government Health Scheme (CGHS) and Ex‑Servicemen Contributory Health Scheme (ECHS) have increasingly incorporated Ayush treatments in their coverage frameworks, he noted.
Small share of claims
Vasudevan said claims related to Ayush treatments still represent a relatively small share of overall health insurance claims. As a result, insurers may not prioritise building deeper expertise around these therapies.
“Ayush claims are still a small fraction of the total claims. From a business standpoint, insurers may not devote too much energy to it,” he said.
However, he added that demand for such treatments appears to be rising, particularly among younger, urban and digitally aware consumers who are exploring alternative and integrative care options.
As the number of accredited Ayush hospitals grows and regulatory support increases, he said the role of insurance coverage in the segment could expand further over time.
