AYUSH Health Insurance Eligibility

According to MoSPI’s AYUSH Survey of 2022-2023, AYUSH therapies are gaining widespread acceptance, with around 46% of rural Indians and 53% of urban Indians using them for prevention or treatment. Recognizing this growing preference, the IRDAI has updated its guidelines, and policyholders can now claim AYUSH expenses under standard health insurance.

But here’s the catch: not every wellness retreat or yoga camp qualifies. 

To ensure claims are honoured, treatments must be taken at recognized facilities with proper infrastructure and documentation. In this guide, we’ll break down the exact AYUSH Health Insurance eligibility requirements so you know how to make the most of your cover in 2026.

Eligibility Criteria of  Ayush Health Insurance

Let’s break down the key requirements according to IRDAI’s master circular on standardization of Health Insurance products.

1) Minimum Hospitalization Period:

The treatment must involve hospitalization for more than 24 hours.

2) Recognized Treatment Facility:

The treatment must take place in one of the following:

• A Central or State Government-recognized AYUSH hospital
• A facility accredited by the National Accreditation Board for Hospitals (NABH) or the National Accreditation Board for Testing and Calibration Laboratories (NABL).

3) Hospital Infrastructure Requirements:

The AYUSH hospital or center must have:

• At least 5 inpatient beds
• A qualified AYUSH practitioner is overseeing the treatment
• Daily maintained treatment records, available for review during claim processing

These criteria ensure that the AYUSH treatment is conducted in a regulated, professional environment, improving both treatment outcomes and claim transparency.

Reasons to Select a Health Insurance Policy with AYUSH Cover

With the increasing popularity of traditional and holistic healing methods in India, AYUSH treatments have emerged as a preferred alternative or complement to allopathic medicine for many individuals. Choosing a health insurance policy that includes AYUSH cover offers several key advantages:

1) Holistic and Personalized Care

AYUSH systems such as Ayurveda, Homeopathy, and Naturopathy emphasize individualized, root-cause-focused treatments. Many policyholders seek these options for chronic conditions, lifestyle issues, and preventive wellness, making health coverage for them more relevant than ever.

2) Regulatory Backing by IRDAI

Since IRDAI backs AYUSH coverage, it ensures policyholders get equal protection and access, whether they choose modern or traditional treatment paths.

3) Cashless Treatment at Accredited AYUSH Hospitals

Under the latest guidelines, insurers are required to build cashless networks for AYUSH hospitals, just like they do for allopathic hospitals. This removes the burden of upfront payments and simplifies the claims process.

4) Coverage Across a Broad Range of Ailments

From stress-related conditions to digestive disorders and chronic pain, AYUSH therapies are increasingly used to treat non-emergency yet persistent health issues. Having insurance that covers these treatments means you can explore them without financial strain.

5) Stronger Oversight and Quality Standards

IRDAI now requires insurers to:

• Define board-approved policies for AYUSH coverage
• Establish standard operating procedures for evaluating claims
• Collaborate with the Ministry of AYUSH’s Core Group of Experts

This framework helps ensure transparency, reduces fraudulent claims, and improves the quality of AYUSH insurance.

Ditto’s Take on AYUSH Health Insurance

While AYUSH coverage in health insurance is a step in the right direction, there are still a few practical and regulatory realities that policyholders should be aware of. 

Insurers treat AYUSH claims just like other allopathic ones as long as hospitalisation is medically necessary and the treatment is administered at a certified facility. 

However, many AYUSH claims still face hurdles because:

• There’s a lack of standardized treatment protocols across AYUSH disciplines.
• Clinical validation and outcome-based research are still evolving.
• Documentation requirements can vary across AYUSH centers.
• Most AYUSH treatments are processed as reimbursement claims, since many government-certified AYUSH hospitals are not part of insurers' cashless networks.

While IRDAI’s regulatory push has improved access, there are still a few critical caveats and exclusions to be aware of.

Exclusions and Limitations to Keep in Mind

• Day care treatments and pre- and post-hospitalisation coverage may not be available under AYUSH.
• Treatments at uncertified or unaccredited centers (like non-NABH/NABL-certified clinics) aren’t covered.
• OPD visits or therapies offered at spas, wellness retreats, or yoga resorts are not eligible for claims.
• Some older or basic policies, such as Star Health Comprehensive, may cap AYUSH treatment expenses (e.g., up to 25% of the sum insured or ₹50,000). However, most newer plans now offer AYUSH coverage up to the full base sum insured.
• Cosmetic or experimental AYUSH procedures, even if done at certified centers, are typically excluded.

Full Disclosure: While most of the claims we handle are allopathic, we're still learning the ins and outs of AYUSH coverage as the space evolves. At Ditto, we recommend double-checking whether your preferred AYUSH center is certified and whether your condition meets the hospitalization criteria. If you're unsure, we’re always happy to help you review your policy or confirm claim eligibility.

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Conclusion

AYUSH health insurance is no longer an optional add-on. It’s now a standard benefit across all health plans. With the proper eligibility checks (certified hospitals, 24-hour admission, proper records), you can access holistic care without worrying about claim rejections.

That said, be mindful of exclusions like spa therapies, uncertified centres, or cosmetic procedures, which insurers won’t cover. If you’re unsure whether your preferred AYUSH hospital or treatment is included, speak to a Ditto advisor, and we’ll verify the fine print and help you pick the right policy.