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Schwabe News Volume 3 | Issue 5 & 6| October & December 2012

Scenario of insurance cover for homoeopathy and other alternative treatments

Draft norms on health insurance, announced earlier this year, allowed insurers to cover non-allopathic treatments done in government hospitals and medical colleges. But general insurance companies had started working on products covering alternative medical treatments, such as ayurveda, homoeopathy, unani, sidha and naturopathy long before that. Experts, however, haven't seen much traction for products extending this benefit. For instance, although Cholamandalam MS General Insurance launched Chola Individual Healthline Insurance policy last year, S S Gopalarathnam, the Managing Director, admits to not seeing as much pull for the product as he had expected.

While Chola Individual Healthline Insurance policy is a standalone health cover, some insurers offer coverage for alternative treatments only under their group policies, like Bajaj Allianz General Insurance. Public sector insurers New India Assurance and Oriental Insurance, Star Health and Allied Insurance, HDFC Ergo and Tata AIG General Insurance cover alternative medical treatments under standalone or individual health insurance policies. Bajaj Allianz General Insurance may soon come out with an individual plan.

In majority of the policies, no standalone cover for alternative treatments is available. One will have to buy a standard health insurance cover from one of these insurers, which will also cover non-allopathic medication. Though many policies offer this benefit, there are curbs on the amount and situations under which one can make a claim. Like treatment under naturopathy is excluded from most of these policies. Experts say there is no standard protocol in case of alternate treatments. Add to that, costs of each of these medication system vary. This makes computation of cover difficult for insurers. Even under ayurveda, some policies cover select procedures only.

Cholamandalam MS General Insurance's product covers only ayurvedic treatments, which can be claimed if the claimer is hospitalised for more than 24 hours. On the other hand, though New India Assurance covers individuals getting treated with the help of ayurveda, homoeopathy and unani medicines, a claim can be made only to the extent of 25 per cent of the sum insured. Importantly, the treatment needs to be availed of at a government hospital.

Similarly, Star Health and Allied Insurance's product does not cover naturopathy. And for ayurvedic, homoeopathy, unani and sidha medicines, one can claim up to 25 per cent of the sum assured or a maximum of Rs 25,000 per occurrence, per policy year.

 

Insurers and their cover for homoeopathy and other alternative treatments

Insurers

Alternate treatments covered

Coverage

 New India Assurance

Ayurvedic, homoeopathy,
unani, sidha

Up to 25% of sum assured

 Oriental Insurance

Ayurvedic, homoeopathy,
unani, sidha

Up to 10% of sum assured in private
ayurvedic hospitals or up to total sum
assured in government hospitals

Cholamandalam
MS General Insurance

Ayurvedic

 

Star Health and
Allied Insurance

Ayurvedic, homoeopathy,
unani, sidha

Up to 25% of sum insured subject to a
maximum of Rs 25,000 per occurrence, a year

HDFC Ergo

Ayurvedic, homoeopathy,
unani, sidha

Up to 20% of the sum assured*

Tata AIG General
Insurance

Ayurvedic, homoeopathy,
unani, sidha

Up to Rs 20,000 if sum assured is less than
Rs 5 lakh and Rs 25,000 if sum assured is
over Rs 5 lakh

* Up to 20%  of sum assured; Maximum Rs 20,000 (for sum assured of Rs 2 lakh and Rs 3 lakh) and Rs 25,000 (for sum assured of Rs 4 lakh)                                                                                                        Source: Company websites

 

Though the benefits are capped, one will be required to pay for the entire policy. For instance, a 35-year-old will need to pay an annual premium of Rs 11,322 for Cholamandalam MS General Insurance's product, for a sum assured of Rs 4.50 lakh. For non-allopathic cover, it would be Rs 33,750. With Tata AIG General Insurance's product a 35-year-old would have to pay Rs 5,000 for a Rs 5 lakh policy. Non-allopathic cover is higher at Rs 25,000.

If the claim for alternate medication is accepted, insurers like HDFC Ergo, do not accept another claim for allopathic treatment for the same disease. “In terms of coverage, Oriental Insurance gives the highest cover because if you get treated (via alternate system) in a government hospital or a medical college you can claim even for the entire sum assured. Otherwise, it is up to 10 per cent of the sum assured,” says Mahavir Chopra of http://www.medimanage.com.

Additionally, many like Star Health and Allied Insurance don't have government hospitals in their network of cashless hospitals. This benefit can also be looked at the time of buying a health cover, but cover for non-allopathic treatments cannot be one of the main criteria for zeroing in on a health insurance policy. Importantly, Chopra says, looking at the cover to premium ratios, you could also do without this benefit because in most cases no hospitalisation is required for ayurvedic and homoeopathy treatments. Also, most turn to alternative medication when allopathy gives up the case and then, there is hardly anything one can do.

It would be better to have a comprehensive health plan, which covers hospitalisation in serious or emergency situations.

Source: Business Standard. Available from: http://www.business-standard.com/india/news/limited-cover-for-alternative-treatment/488975/