Stakeholders Discuss Regulatory Framework to Integrate Ayush Treatments into Health Insurance

The meeting was prompted by the recent directives from the Insurance Regulatory Development Authority (IRDAI) to include Ayush treatments under health insurance cover starting April 1, 2024.

In a significant step towards making Ayush treatments accessible to all, stakeholders gathered to discuss the regulatory framework and policy support needed to integrate Ayush treatments into health insurance schemes. The sensitization program, organized by the Ministry of Ayush, brought together insurance companies and Ayush hospital owners at the All India Institute of Ayurveda (AIIA).

The meeting was prompted by the recent directives from the Insurance Regulatory Development Authority (IRDAI) to include Ayush treatments under health insurance cover starting April 1, 2024. The goal is to foster a deeper understanding between Ayush healthcare providers and the insurance sector to promote affordable Ayush healthcare for citizens.

Secretary, Ministry of Ayush, Vaidya Rajesh Kotecha, stated: “The aim is to ensure easy access to Ayush treatments for everyone. A significant milestone was achieved with the joint publication of standard treatment guidelines by DGHS & Ayush (STG), marking a first-of-its-kind integration in India. This focus on accessibility is coupled with remarkable growth in the sector, with the manufacturing of Ayush products increasing eightfold in the last decade.”

Director, AIIA, Prof. Tanuja Nesari, noted: “We're making significant strides in integrating Ayush treatments into the mainstream healthcare system. Our collaboration with insurance companies focuses on enabling cashless access to Ayush services through the TPA network. Today's meeting is a pivotal step in this journey, bringing us closer to realizing our vision of making Ayush treatments accessible and affordable for all.”

Chairman, Core Group of Experts for Insurance, Ministry of Ayush, Prof. Bejon Kumar Misra, emphasized: “A key recommendation is to promote Ayush HCO empanelment and adopt Ministry of Ayush-approved Standard Treatment Guidelines (STGs), ICD-TM2 codes, and increase Ayush representation on key committees.”

MD & CEO, Apollo AyurVAID Hospitals, Shri Rajiv Vasudevan, added: “The current insurance services are largely focused on surgical and emergency services, but two-thirds of the sector belongs to people dealing with long-term diseases. Effective healthcare is required for patients with long-standing issues, recurring issues, autoimmune diseases, and neurodegenerative diseases. Ayush treatments will also be highly effective in palliative and end-of-life care.”

Further Developments:

Mr. Mishra further mentioned that the General Insurance Council is expected to lead on behalf of its 39 general insurance, standalone health insurance, reinsurance, and specialized insurance companies in publishing a White Paper on this initiative.

The program included discussions on various issues such as insurance coverage in the Ayush sector, standard treatment guidelines, the penetration of Ayush in the insurance sector, and the onboarding of Ayush hospitals on the ROHINI platform for insurance coverage.

Adviser, Ministry of Ayush, Dr. Kousthubha Upadhyaya, said: “The Ministry of Ayush has constituted a Core Group of experts for the insurance sector in October 2023 to advise and monitor insurance-related matters in the Ayush sector. This group will also conduct a study on the current status of Ayush systems under health insurance and create a white paper.”

Deputy Director General (Ayush) Ayush vertical in Director General of Health Services, Dr. A. Raghu, highlighted: “A flat rate design is required since Ayush treatments require longer stays and should be classified based on Rog Bal (disease strength) and Rogi Bal (patients’ strength). He also emphasized the need for three levels of medical management (Mild/Moderate/Severe) for each disease where treatment duration should be systematically derived by experts.”

The Ministry of Ayush and the National Health Authority (NHA) are working towards including Ayush interventions in the Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), furthering the goal of comprehensive healthcare coverage for all.