Understanding the Role of TPAs in Health Insurance

Long before allopathic medicines and treatment became the norm, alternative medicine like Ayurveda and Homoeopathy dominated the Indian medicine industry. Health experts also believed that yoga could cure various types of physical ailments. So, in 2013, when the Insurance Regulatory Development Authority of India (IRDAI) instructed insurance companies to introduce AYUSH treatment insurance, insurance buyers wholeheartedly welcomed the change. This article explains AYUSH treatment cover in health insurance.

An acronym for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy, AYUSH represents a health care system focused on alternative medicine or treatment. These alternative treatments are traditionally less expensive than allopathy and cause fewer side effects.

The Government of India introduced the AYUSH ministry to promote and develop traditional and alternative medicine. The government further mandated general and standalone health insurance companies to provide health insurance to people who prefer these conventional courses of treatment.

Individuals who opt for treatment through AYUSH medicine can undergo various kinds of drug therapies to treat illnesses using their AYUSH cover.

Health insurance which covers AYUSH comes with its own list of inclusions and exclusions. They are as under:

You can file a claim for the following expenses under the AYUSH treatment cover:

• AYUSH treatment expenses incurred at government hospitals accredited by the National Accreditation Board of Health (NABH) or the Quality Council of India (QCI).
• Expenses incurred during an in–patient treatment at NABH and QCI–accredited facilities offering therapies like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
• The costs associated with enrolment fees you pay as a policyholder to Yoga institutes within your state as a part of your preventive wellness.

The insurance provider is not obligated to cover the expenses associated with the following under your AYUSH treatment insurance.

• Outpatient treatments that do not require hospitalisation or lodging, i.e., treatments completed within 24 hours.
• Expenses associated with pre and post–hospitalisation, day–care procedures, and alternative treatment costs resulting from out–patient medical care.
• Preventive or rejuvenation treatments that are not deemed medically necessary or prescribed by licenced practitioners.

The following are the advantages of opting for a medical insurance policy with AYUSH cover:

• You can enjoy a more holistic and natural approach to healthcare.
• You get in–depth resolutions for various ailments with an emphasis on overall wellness rather than providing short–term relief.
• The body can absorb natural ingredients more efficiently, reducing the chances of harmful side effects.
• The negligible side effects make it an excellent alternative treatment for older adults and senior citizens whose bodies are not equipped to absorb harsh allopathic medicines.
• AYUSH treatment also helps individuals battling lifestyle issues like tobacco, drug, and alcohol addiction.

Despite the IRDAI guidelines, only a few health insurance companies in India currently offer the AYUSH treatment cover. However, it helps to have both an AYUSH policy and a regular medical insurance plan. You must research and compare the coverage offered under both AYUSH and general health insurance policies before purchasing them.

In times of medical emergencies, financial burdens are often the last thing anyone wants to face. This is where the cashless hospitalization facility in health insurance plays a vital role, offering individuals and families financial relief by enabling them to access hospital care without the immediate need for out-of-pocket payments. This article explains how cashless hospitalization works, its benefits, and how to select the best cashless health insurance policy.

Leprosy is one of the most ancient diseases. It is also called Hansen’s Disease, after the Norwegian physician Gerhard Henrik Armauer Hansen who discovered the bacteria that causes leprosy. In 2020, the World Health Organization noted 127558 new leprosy cases globally. As leprosy is a bacterial disease, it is known to affect the skin and lead to the appearance of external lesions and sores. Leprosy also affects the nerves and muscles. If left untreated, this disease can disfigure the patient.

Let’s take a closer look at what causes leprosy, examine the symptoms, and explore treatment options.

Causes of leprosy

Leprosy is caused by the Mycobacterium Leprae Bacterium. As a disease, leprosy is not highly contagious. It only spreads through close contact with a patient who already has the condition. Studies show that Mycobacterium leprae bacteria can spread through sneeze or cough droplets from an infected patient to others.

There is a lot of stigma around leprosy. Patients are often shunned from society and forced to live in isolation. It is, therefore, important to note that leprosy does not spread if you sit next to an infected person in public transport or shake hands with them once. To actually spread the disease, there has to be close and repeated contact with a patient. Once a patient has begun treatment, they can no longer pass on the infection to others.

Expectant mothers cannot transmit leprosy to an unborn child.

Types of leprosy

Leprosy is broadly classified into two main types. These are lepromatous and tuberculoid. Tuberculoid is a milder form of the disease and relatively less contagious. Lepromatous is very contagious and affects the kidneys apart from causing major disfigurement and hair loss.

There is also a third type of leprosy which is called borderline. Borderline is a type in which the patient exhibits symptoms of both the lepromatous and tuberculoid forms.

Symptoms of leprosy

Several years may pass before a patient exhibits noticeable signs of leprosy. In fact, some studies indicate that symptoms may even appear anywhere between 5 and 20 years after the initial infection.

Symptoms to note include light-coloured skin lesions, muscle weakness, lumps on the skin, dry skin, and a loss of sensation in the limbs.

Leprosy can also lead to nerve damage, blindness, kidney failure, hair loss, and loss of use of hands and feet. There is a common misconception that leprosy causes fingers to fall off. This is untrue. What really happens is that the bacterial infection leads to a loss of sensation in the affected areas. This loss of sensation means that burns, cuts, and other wounds go unnoticed until they eventually lead to infection that causes permanent damage.

Diagnosis and treatment of leprosy

If a skin sore is suspected to be a sign of a leprosy infection, the patient will be advised to undergo a biopsy. In a skin biopsy, a small sample of the affected area will be taken and sent for testing. The patient may also be advised to undergo a skin smear test or a lepromin test.

The diagnostic tests aim to identify the type of bacteria and type of leprosy. Upon proper identification of the type of leprosy, the course of treatment can be decided.

The good news is that leprosy can be cured. Treatment for leprosy involves multi-drug therapy which has been developed by the World Health Organization.

Patients need to take prescribed medication for an extended period of time that can range anywhere from a few months to a year. The medication is usually a combination of antibiotics for the bacteria and steroids for inflammation. Certain medicines used to treat leprosy might not be suitable for pregnant women as they may cause birth defects. If an expectant mother is undergoing treatment, her doctor may avoid prescribing certain medicines.

Living with leprosy

Patients living with leprosy are often isolated and excluded. This happens due to a lack of awareness among the masses on the exact nature of the disease. Once a patient has begun their course of multi-drug therapy, they can live normally with their family without worry of infecting them. They can attend office, shop for their necessities, and follow their normal routine. Proper education and awareness among the masses will help reduce the social ostracization faced by people living with leprosy.

Health insurance and leprosy

These days, medical procedures can run into lakhs of rupees. And it is not wise to deplete one’s savings in paying for medical costs. A health insurance plan is the only way to afford the rising cost of healthcare. Health insurance covers hospitalisation expenses as well as charges incurred pre- and post-hospitalisation within limits specified by the insurer. It is much easier to pay a premium each year than pay an actual hospital bill each time you fall ill.

Does health insurance cover leprosy?

Insurers in the country are known to include coverage for leprosy under a critical illness cover. A critical illness cover is a rider that you can add to your health insurance plan for an extra premium. Most riders are affordably priced and so it does seem advisable to add as much coverage as you can to your base health insurance plan. This way, you can enjoy peace of mind with the knowledge that you are covered. Do bear in mind that health insurance policy inclusions can vary between insurance providers. You must read the fine print and ask your insurer what extent of coverage is offered before you buy insurance.

SBI General offers a range of medical insurance plans that are designed to offer holistic coverage when you fall ill. These plans include coverage for hospitalisation expenses (room rent, nursing costs, etc.), doctor’s fees, charges for anaesthesia and oxygen, procedural costs, and ambulance charges. Patients can also make a claim for day care procedures. SBI General offers its policyholders access to over 6000 cashless hospitals in India for cashless treatment. There is also a benefit of a free health check-up once in every four claim-free years.

Apply for health insurance today with SBI General to enjoy true peace of mind.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.