IRDAI’s new guidelines allow patients to take treatments from all Ayush hospitals irrespective of NABH or state level certifications

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IRDAI’s new guidelines allow patients to take treatments from all Ayush hospitals irrespective of NABH or state level certifications
25-Jan-20 08:23:15

The new standard health insurance policy, Arogya Sanjeevani, introduced by the Insurance Regulatory and Development Authority of India (IRDAI) on January 1 this year helps easy availability of health benefits for patients taking Ayush treatments from all Ayush institutions irrespective of NABH or state level certifications.

As per the insurance policy (Arogya Sanjeevani), NABH accreditation or state level certification for institutions is not a criterion for availing insurance benefits for Ayush treatments from central or state government hospitals and locally registered institutions. The new provision of IRDA is applicable to institutions of all Ayush streams.

Mandating this provision, IRDAI issued guidelines in this regard to all general and health insurance companies on January 1, 2020. The new guidelines, Guidelines on Standard Individual Health Insurance Product, allay all concerns of the Ayush sector with regard to health benefits for the insured patients.

Concerns arose in the Ayush sector due to the IRDA’s earlier circular of 26th November, 2019, on ‘Modified Guidelines on Standardization in Health Insurance’, which mandated that patients taking treatments from NABH certified institutions or hospitals obtained state level certifications were eligible for reimbursement of their treatment expenses. Against these mandatory guidelines, a registered Ayurveda society from Kozhikodu in Kerala, Kerala Ayurveda Cooperative Society (KACS), had approached the IRDA and the Union Ayush ministry in November last year urging them to nullify the mandatory provision of NABH and state accreditation for institutions.

Dr. MM Sanal Kumar, president of the society handed over memorandum to the Union ministers and members of Parliaments from Kerala seeking relaxations to Ayurveda institutions in the state. Resultantly, the Regulatory Authority has relinquished its mandate for the central or state certifications.

As per Arogya Sanjeevani health policy, an Ayush hospital is a healthcare facility wherein medical or surgical or para-surgical treatment procedures and interventions are carried out by Ayush medical practitioners. The categories of facilities include central or state government Ayush hospitals or teaching hospital attached to Ayush colleges recognized by the central authorities. The category also includes standalone hospitals or hospitals co-located with in-patient healthcare facility of any recognized system of medicine registered with the local authorities.

The main criterion is that the Ayush hospital, from which the insured patient takes treatments, should have at least five IP beds and it must be supervised by Ayush medical practitioner with round the clock responsibility. The facilities in the hospital should comprise dedicated Ayush therapy sections as required under all medical rules and a well-equipped operation theater where surgical procedures are to be carried out. Other condition is that the hospital should maintain daily records of the patients and making them accessible to the insurance company’s authorized representatives.

According to the guidelines, an Ayush Day Care Centre (ADCC) can be a community health centre (CHC) or primary health centre (PHC) or dispensary or clinic or polyclinic or any such health centre which is registered with the local authorities. Such centres should have facilities for carrying out treatment procedures and medical or surgical or para-surgical interventions or both under the supervision of registered Ayush medical practitioners on day care basis without IP services. Other provisions mandated for the Ayush hospitals are also applicable to ADCCs, according to the new guidelines issued by the IRDAI.

While speaking to Pharmabiz, Dr. Sanal Kumar said, Kerala Ayurveda Cooperative Society is organizing a workshop on January 24 at Thiruvananthapuram to explain about the new guidelines on health insurance benefits. All associations of doctors, ayurveda drug manufacturers and Ayush hospitals will attend the one-day workshop. He said patients following Ayush systems can also participate in the meeting.