Health Insurance pay for OPD treatments: As alternative therapies like Ayurveda, homeopathy, naturopathy and acupuncture become more mainstream, many health insurance customers are left wondering whether these treatments are actually covered—especially when they are taken as outpatient (OPD) care. A reader recently wrote in seeking clarity on how insurers treat alternative medicine under existing health insurance policies.
Ask Wallet-Wise is an initiative that brings expert guidance on personal finance and insurance-related questions. You can write to askwalletwise@nw18.com, and we’ll get an industry expert to address your query.
Does health insurance cover alternative treatments under OPD?
Expert view: The answer depends on whether your policy offers AYUSH benefits and how it defines outpatient (OPD) treatment.
Under guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI), all health insurance policies must provide coverage for AYUSH treatments—Ayurveda, Yoga, Unani, Siddha and Homeopathy. However, this coverage is typically restricted to in-patient hospitalisation at government-recognised or accredited AYUSH hospitals or treatment centres. The extent of coverage is also subject to policy terms, conditions and sub-limits.
For most policyholders, it’s important to understand that OPD consultations for alternative therapies are generally not covered under standard health insurance plans. Insurers continue to focus largely on hospitalisation-related expenses, while routine outpatient visits, follow-ups or wellness therapies remain excluded.
Treatments such as acupuncture or naturopathy may be covered only if they are part of a recognised AYUSH therapy and require hospital admission at an eligible facility. Standalone OPD sessions or wellness-focused therapies are usually outside the scope of coverage. Even when AYUSH hospitalisation is allowed, insurers often impose caps or sub-limits, and claims depend on factors like medical necessity and whether the treatment centre meets the policy’s eligibility criteria.
That said, a few insurers are beginning to offer broader benefits. For instance, Aditya Birla Health Insurance has introduced OPD coverage for select AYUSH treatments through its Health Meter+ feature, reflecting a growing focus on preventive and holistic healthcare.
The bottom line
While AYUSH hospitalisation cover is mandatory under IRDAI rules, OPD coverage for alternative treatments is usually excluded unless explicitly mentioned in the policy. If you regularly rely on alternative medicine, it’s essential to read the policy wording carefully and check whether your insurer offers benefits beyond the regulatory minimum. This small step can help avoid surprises at the time of a claim.