AYUSH Treatment

What is AYUSH treatment?

AYUSH is an umbrella term used for five recognized systems of traditional and alternative medicine in India:

• A – Ayurveda
• Y – Yoga and Naturopathy
• U – Unani
• S – Siddha
• H – Homoeopathy

AYUSH treatment refers to healthcare provided under these systems. Each system follows its own approach to health and treatment. AYUSH treatment can be provided in hospitals, clinics, and other healthcare facilities that meet the applicable recognition and regulatory requirements.

What are the different types of AYUSH treatment?

The term AYUSH covers different systems of medicine. Here's what each one means.

1. Ayurveda

Ayurveda is one of India's traditional systems of medicine. It takes a holistic approach to health and uses medicines, diet, lifestyle changes, and therapies based on Ayurvedic principles. Some commonly known Ayurvedic therapies include Panchakarma and other therapeutic procedures.

2. Yoga and naturopathy

Yoga and naturopathy focus on using lifestyle-based and natural approaches to support health. Yoga may include physical postures, breathing exercises, meditation, and other practices. Naturopathy may use approaches involving diet, exercise, natural therapies, and lifestyle changes.

3. Unani

Unani is a traditional system of medicine that originated in the Greco-Arabic medical tradition and developed further in South Asia. It uses its own principles of diagnosis and treatment and may involve medicines, diet, and lifestyle recommendations.

4. Siddha

Siddha is a traditional system of medicine that has its roots in South India. It uses medicines, therapies, diet, and lifestyle practices based on Siddha principles.

5. Homoeopathy

Homoeopathy is a system of medicine that uses highly diluted substances as part of its treatment approach. It is also included within the AYUSH framework in India.

Is AYUSH treatment covered by group health insurance?

AYUSH treatment can be covered under group health insurance. The policy may have specific conditions related to:

• Eligible AYUSH treatments and healthcare facilities
• Hospitalization requirements
• Coverage limits or sub-limits
• Cashless treatment availability
• Exclusions and non-medical expenses
• Documents and procedures required to file a claim

What does AYUSH treatment cover usually include?

Depending on the terms and conditions, eligible expenses may include costs related to treatment at an eligible AYUSH hospital or healthcare facility.

These may include:

• Hospitalization expenses
• Treatment expenses
• Practitioner or consultation charges
• Medicines and other eligible medical expenses
• Pre- and post-hospitalisation expenses, if included

It is important to check the policy before treatment because some plans may cover only specific expenses or may have separate limits for AYUSH treatment.

What is not necessarily covered under AYUSH treatment?

Depending on the health insurance policy, some treatments and expenses may be excluded or subject to specific conditions.

Hospital stays of less than 24 hours: Some policies cover AYUSH treatment only when the employee is hospitalized for the required duration. Short stays or day-care treatment may not be covered unless specifically included.

OPD consultations and medicines: AYUSH consultations, medicines, and other outpatient expenses may not be covered if the policy does not include OPD benefits.

Wellness and rejuvenation treatments: Expenses for spa services, beauty treatments, wellness programs, or rejuvenation therapies may not qualify as medical treatment under the policy.

Treatment at unrecognised facilities: Expenses incurred at an AYUSH centre or hospital that does not meet the insurer's eligibility or recognition requirements may not be covered.

How to claim AYUSH treatment under group health insurance

The claim process depends on the insurer and the type of treatment. Generally, it can involve the following steps.

Step 1: Check your health insurance policy

First, confirm that your policy includes AYUSH treatment coverage.

Look for information about:

• Covered AYUSH systems
• Coverage limits
• Eligible hospitals
• Hospitalization requirements
• Exclusions
• Claim process

Step 2: Choose an eligible healthcare facility

Before starting treatment, check whether the hospital or facility meets your insurer's requirements. If you want to use cashless treatment, also check whether the facility is part of the insurer's network.

Step 3: Inform your insurer or TPA

For planned treatment, you may need to inform the insurer or TPA in advance. Your policy will specify the applicable process and timelines.

Step 4: Keep all treatment documents

Depending on the claim, you may need documents such as:

• Health insurance card or policy details
• Doctor's prescription
• Medical reports
• Treatment records
• Hospital bills
• Pharmacy bills, where applicable
• Payment receipts
• Discharge summary
• Claim form
• Identity or other supporting documents

Step 5: Submit the claim

Submit the required documents through the insurer, TPA, or the process specified by your group health insurance plan. The insurer will assess the claim against the terms and conditions of the policy.

What should you check before taking AYUSH treatment?

Check your policy limits

Some policies may have a separate limit or sub-limit for AYUSH treatment.

Check whether your treatment is eligible

Your policy may define which treatments and expenses qualify for coverage.

Check the facility

Make sure the hospital or healthcare facility meets the insurer's requirements.

Check if hospitalization is required

Some policies may provide AYUSH coverage only when specific hospitalization conditions are met.

Check the claim process

Know whether you need pre-authorisation, advance notification, or specific documents.

Check exclusions

Read the exclusions carefully so you know which expenses you may have to pay yourself.Talk to Pazcare to understand and manage your group health insurance coverage.