Alternative Treatment Cover in Health Insurance

Buying health insurance means 360-degree coverage for medical expenses. But does your health insurance cover alternative treatment? If you don’t know, check the policy document. ​Not all policies provide you the same. So, you must read the policy documents carefully at the time of purchasing health insurance. Many people want to take alternative treatment as they believe it helps eliminate the illnesses or diseases from their roots. In 2013 Insurance Regulatory and Development Authority of India (IRDAI) asked the insurance companies to provide alternative treatment as a part of base coverage. Read this page and know more about the same.

Coverage for Alternative Treatment

You will get coverage for AYUSH, which stands for Ayurveda, Yoga, Unani, Siddha and Homeopathy systems of medicines, up to the sum insured. You can file a claim for alternative treatment in case of illness. injury or disease.

Is Alternative Treatment a Mandatory Cover in Health Insurance?

No, it is not, the insurer coverage for the treatment may vary from plan to plan. For instance, in a comprehensive health policy, all the basic medical expenses are covered so is the alternative treatment. But a dedicated health insurance plan provides coverage for such expenses only that are mentioned in the policy documents. An example of a dedicated health insurance plan is maternity cover. In this, the company will pay for the expenses that are related to pregnancy and mentioned in the list of coverage. If you buy such a health insurance policy, there won’t be any alternative treatment cover.

Where Can I Receive This Treatment?

You can receive treatment at a government hospital or any institution recognized by the central or state government for AYUSH treatment. The company won’t cover your expenses if you seek treatment at an unrecognized institution. You will get the cover for both in-patient and domiciliary hospitalizations. If your home treatment exceeds more than three days, it is called domiciliary treatment and can get covered under a health insurance policy. But the treatment must be taken at home due to a valid reason such as the unavailability of room at the hospital or the patient’s condition.

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Does the Insurer Cover My Alternative Treatment for COVID-19?

Yes, you’ll get coverage for COVID-19 under the alternative treatment section as well. But the same is claimable if you’re diagnosed with the same during the policy term at a recognized government center. Medical investigations showing that the person was affected with COVID-19 before the policy purchase would lead to claim rejections. So, take care of these things while filling a claim for the treatment.

How do Insurers Cover Alternative Treatment Expenses?

The insurer will provide you with reimbursement and cashless facilities. So, if you take alternative treatment at a network hospital, the insurer will pay your bills directly to the hospital. In a cashless claim, you don’t need to pay the hospital bill during discharge/admission.

Whereas, in a reimbursement claim, you need to pay the bills upfront. Once you’re discharged, collect the bills and submit them to the insurer along with a duly filled claim form. Upon receiving the same, the insurer will verify documents and approve/reject your claim basis the same.

If the company approves your claim, it will reimburse the expenses to your bank account.

Reasons for Claim Rejection

The following are some of the common reasons that can result in AYUSH treatment claim rejection –

  • Hospitalization is less than 24 hours
  • Daycare procedure
  • Outpatient treatment
  • Treatment at a facility that is not a hospital
  • Evaluation or investigation
  • Preventive and rejuvenation treatment that the attending medical practitioner doesn’t advise
  • Spas, massages, and other procedures

Which Insurance Companies Offer You Alternative Treatment Cover in Health Insurance?

The following are some of the top insurance companies in India that offer the same –

  • ICICI Lombard
  • NIVA Bupa
  • Star Health
  • Aditya Birla
  • Care
  • IFFCO Tokio
  • Cholamandalam
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So, if you’re looking for a health insurance plan with alternative treatment cover, do consider the above insurers.

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