Saga of Insurance coverage to Ayurvedic treatments

In a country like India where considerable percentage of the society depends on Ayurveda for various ailments, Ayurveda community and the citizens of India have been demanding for the inclusion of Ayurvedic treatments under Health Insurance coverage for long time. Ayurveda Hospital Management Association (AHMA) – Association for Ayurvedic Hospitals - was demanding and trying for this approval for several years. But, the personalised treatment approach of Ayurveda was the main barrier for calculation of reimbursement cost for Ayurvedic treatments and hence its inclusion under insurance coverage. Because of this barrier, this demand was not resulted in success.

In the year 2010, Dept. of AYUSH has taken a serious step for the inclusion of Ayurvedic treatments under insurance coverage with active involvement of Ayurveda Hospital Management Association (AHMA). Dr.Induchoodan - Treatment Standardisation & Accreditation committee Convener, AHMA- had prepared a treatment protocol with costing method for Ayurvedic treatments for its inclusion under Insurance coverage which was subjected to analysis and clarifications in various meetings of Ayurveda Hospitals convened by AHMA. Then the unanimously approved protocol with costing was submitted to Dr.Janardan Panday the then Joint Advisor AYUSH by AHMA General Secretary Dr.Babykrishnan on 21 st May 2010 at Thrissur. On 18 th October 2010, on behalf of Dept. of AYUSH, Dr.S.K.Sharma (Advisor-AYUSH), Dr.Janardan Panday (Joint Advisor AYUSH), Dr.Babykrishnan, Dr.D.Induchoodan and Dr.Anwar presented this Protocol with costing to General insurance council Mumbai.

Eventhough IRDA suggested inclusion of Ayurvedic treatments under insurance coverage after this incidence, since different insurance firms insisted various conditions in their policies, Ayurvedic community was not able to obtain the required benefits. Hence, AHMA continued its struggle through all possible ways to avail the benefit to patients taking treatments in all Ayurveda hospitals. When the Central Govt. under the leadership of Prime Minister Narendra Modi formed a separate AYUSH Ministry to focus the development and promotion of AYUSH systems, AHMA channelised the follow- up through that. AHMA officials met AYUSH Minister Shripad Yasso Naik, explained the details and submitted the request. The Minister assured them to take necessary action.

Realising the significance of inclusion of AYUSH systems under insurance coverage, Ministry of AYUSH contacted various stakeholders and convened a meeting on 12 th July 2016 under the Chairmanship of AYUSH Secretary Ajit M.Sharan to discuss and consolidate AYUSH information document for the same. The Ayurvedic treatment protocol with updated treatment rates (considering increase in expenses in 2016) submitted by AHMA official Dr.Induchoodan to AYUSH was accepted by the stakeholders in this meeting since it satisfied the requirements of both Ayurvedic and insurance sectors. Dr.P.R.Ramesh Varier (Supdt. Kottakkal Arya Vaidya Sala, Delhi) who was also a member of that committee had highly supported AHMA in this venture. On 30 th September 2016, Ministry of AYUSH released the ‘Guidelines for reimbursement/settlement of Ayurvedic treatment expenditure claims under insurance coverage’. This Guidelines specifies criteria of eligible hospitals for insurance coverage, tentative list of diseases/disease conditions needing hospitalisation of the patients, Clinical conditions for hospitalisation, indicative therapies and likely duration of hospitalisation and benchmark costing of Ayurvedic therapies/interventions. etc.

AHMA is so much thankful to officials like A.M.Sharan (Secretary-AYUSH), A.K.Ganeriwala (Joint Secretary-AYUSH), P.N.Ranjith Kumar (Joint Secretary–AYUSH), Dr.D.C.Katoch (Advisor Ay.–AYUSH), Dr.Pradeep Kumar Dua Research officer (Ay) – AYUSH, Dr.Janardan Pandey (Former Joint Advisor –AYUSH), Dr.S.K.Sharma (Former Advisor –AYUSH) ..etc for their sincere effort in this achievement.

Dr.P.M.Varier, Dr.Muhammed Bappu, Dr.C.S.Krishnakumar, Dr.Sanal Kurinjikkattil, Dr.E.T.Neelakandan Mooss, Dr.Rahmathulla, Dr.Sajikumar, Dr.A.M. Anwar, Dr.B.G.Gokulan, Dr.I.Unnikrishnan Namboothiri, Mr.K.P.Wilson Kandamkulathy…etc also had taken great efforts at different stages to attain this success.

Eventhough more insurance firms introduced Insurance policies covering Ayurveda after this, it hasn’t produced the full benefit to Ayurvedic patients because total costs of individual disease to be covered are essential for insurance firms to introduce new policies since they need that cost to fix premium of new policies. Considering this essential requirement of insurance sector, the protocol and costing submitted by AHMA with the approval of Ayurvedic sector had included that part also which is missed in the Guideline published by Ministry of AYUSH. This exclusion of total cost for treatment of individual diseases is expected to be the major setback in getting its real benefit to Ayurvedic patients.

Apart from this, some discrepancies occurred in the eligibility criteria of Hospitals for insurance coverage in the above mentioned guideline. The criteria fixed for number of required Doctors, paramedical staff, number of beds..etc in private Ayurveda hospitals are more complex than the criteria for NABH accreditation; at the same time, NABH accredited hospitals are made eligible for insurance coverage without these terms. Hence, AHMA is trying to solve the remaining issues also.