Hyderabad – As of April 2026, claim settlement for AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) has undergone a significant regulatory shift in India. Under the latest IRDAI (Insurance Regulatory and Development Authority of India) guidelines, insurance providers are now required to treat AYUSH treatments on par with Allopathy. This means that for modern health insurance policies, policyholders can often claim expenses up to the full sum insured, with many previous “sub-limits” or “caps” being removed.
Key Requirements for a Successful Claim
To ensure your AYUSH claim is honoured, you must meet specific criteria that distinguish medical necessity from general wellness:
- The 24-Hour Hospitalisation Rule: Most standard policies still require a minimum of 24 hours of inpatient hospitalisation. Outpatient (OPD) consultations or quick procedures are generally excluded unless you have a specific OPD rider.
- Facility Accreditation: Treatment must be sought at a government-recognised or NABH (National Accreditation Board for Hospitals) accredited AYUSH hospital. Stays at “wellness retreats,” “spas,” or “rejuvenation centres” typically result in claim rejection.
- Hospital Infrastructure: The facility must have at least 5 inpatient beds and a qualified, registered AYUSH practitioner in charge around the clock.
- Curative vs. Wellness: Claims are only valid for curative treatments for diagnosed medical conditions (e.g., Arthritis, Psoriasis). “Rejuvenation massages” or “detox packages” for general de-stressing are viewed as lifestyle choices and are not covered.
How to File Your Claim
- Cashless Everywhere: Many insurers now offer a “Cashless Everywhere” facility, allowing you to get treated at non-network hospitals if they meet the required accreditation standards. You must notify your insurer at least 48 hours prior for planned treatments.
- Reimbursement: If cashless is not available, collect all original documents—including the doctor’s prescription, daily treatment logs, and itemised bills—and submit them within 15–30 days of discharge.
- Digital Speed: The integration of the National Health Claims Exchange (NHCX) has slashed settlement times from weeks to hours for digital claims.
