AYUSH or Ayurveda claim rejected?
In-patient Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy treatment can be claimed under most health policies. Rejections usually turn on the hospital or the policy’s own definition.
The rule
Under the IRDAI (Insurance Products) Regulations 2024, every insurer must have a board-approved policy that places AYUSH treatment at par with other treatments. IRDAI’s 2024 health insurance master circular repeats this.
How most policies define an AYUSH hospital
IRDAI’s 2020 standard definitions were repealed as regulation in 2024, but most policies still use them. Typically, an AYUSH hospital is one of these:
- a government AYUSH hospital or a teaching hospital attached to an AYUSH college; or
- a registered facility with at least 5 in-patient beds, a qualified AYUSH practitioner round the clock, a dedicated therapy section or theatre, and daily patient records.
Common reasons given, and how to test them
- “Not a recognised AYUSH hospital”: compare the centre’s registration and facilities with the definition in your policy, not a general one.
- “Wellness or spa treatment”: check whether the discharge summary records a diagnosis and active treatment.
- “Sub-limit applied”: a sub-limit on AYUSH must be written in your policy. If it isn’t, there is no basis for it.
- No clause cited: a rejection or partial payment must refer to the specific policy terms.
What to do
- Get the AYUSH hospital definition and any AYUSH sub-limit from your policy wording.
- Ask the centre for its registration certificate and a note on its beds, practitioners and therapy section.
- Write to the Grievance Redressal Officer, then go to the Insurance Ombudsman if needed.
Questions people ask
Is Ayurvedic treatment covered by health insurance?
IRDAI requires insurers to place AYUSH treatment, including Ayurveda, at par with other treatments under a board-approved policy. The exact cover, hospital definition and any sub-limit are set by your policy wording.