Health insurance: Irdai issues guidelines on wellness, preventive measures

Topics IRDAI | Health Insurance | health

The guidelines are effective immediately, and subsequently people can expect better and more value added benefits to their policy
Everyone likes a discount, voucher, rewards or anything that's free. Did you know you could now get a voucher and discount on your tennis club membership, for buying nutritional supplements or even medicines? To popularise wellness and preventive features in health insurance, the insurance regulator Insurance Regulatory and Development Authority of India (Irdai) has issued guidelines on wellness and preventive measures. 

Gurdeep Singh Batra, Head - Retail Underwriting, Bajaj Allianz General Insurance says, "This was a much-awaited move, which shall also help to give the necessary impetus to health insurance products. It will allow us to reward customers in various ways, specifically like discounted outpatient consultations or treatments, pharmaceuticals, health check-ups/diagnostics etc.,"You may get wellness and preventive features under a policy either as optional or add-on cover. As a part of promoting wellness and preventative regime, insurers may offer reward points to those policyholders who comply with or meet the set criteria of wellness and preventive features. This will nudge you towards making better health choices every day. 

Amit Chhabra, Health Business Head,  says, "With this move, we believe that health insurance will no longer be perceived just as a measure to secure oneself against unforeseen illnesses, rather it will become a part of customer's daily health needs." 

Features: Apart from those mentioned above, there are several features which you can expect your insurance policy to be loaded with. For instance, you can get redeemable vouchers to obtain health supplements. Chhabra says, "This will encourage insurance policyholders to use facilities like gyms, yoga studios, and fitness centers; which should help increase overall health levels in the country. This is very much in alignment with the 'Swasth Bharat Mission' of the government of India." In short, you can get redeemable vouchers of membership for yoga centres, gymnasiums, sports clubs and even fitness centres for participating in fitness activities.

You can get discounts on premiums and/or increase in sum insured at the time of renewals based on the wellness regime followed by you in the preceding policy period. This will be allowed provided increase in sum insured is independent and is not linked to the cumulative bonus offered, if any. Another service which you may get is the coverage of cost of treatment of any admissible claim in respect of non-payable items that are specified under the terms and conditions of the base policy. Keep in mind, where more than one reward is offered, you can choose as per your requirement or need.

The regulator has asked insurers not to promote products or services of any particular third-party service provider, and give policyholders enough choices across multiple service providers for providing benefits/services.

Pricing: The guidelines are effective immediately, and subsequently people can expect better and more value added benefits to their policy. As far as pricing of these features go, it won't impact the premiums in a big way. The Irdai circular says, "Any wellness and preventive feature shall be designed only with the objective of maintaining and improving good health, thereby enabling affordable health insurance.

This means that the insurance company will assess the pricing impact of wellness and preventive features they offer, and in case, there is any they will have to disclose upfront to Irdai. Yes, they will be factored into the pricing of the underlying health insurance product, but it's expected to be affordable. In fact, there will be no discrimination as far as these value-added features go and in granting the reward points to the same or similarly placed categories of policyholders of the underlying health insurance product. The good part is that not only the new health policies will have a number of these features, but existing products are allowed to be modified to incorporate these features. 

Batra says, "In the post-Covid-19 world, where health is perhaps the topmost priority for most, this move is the much needed fuel on an already existing spark of health more seriously and regularly. This, in its true sense, shall help policyholders to monetise the reward points earned by them by following a certain wellness regime. This shall help achieve the desired objective of maintaining and improving good health and enabling affordable health insurance". 
Quick Facts
  • In the case of Family Floater Plans, which accrual and redemption of rewards are considered in respect of all members covered, has to be well communicated.
  • Insurers shall clearly specify in the policy contract as to whether the accrued rewards can be carried forward or not when the policy is renewed.
  • Give clarity regarding the period of validity of the accrued rewards under both the scenarios.
  • In the case of expiry of policy, the accrued rewards may be carried forward for a period not exceeding three months.
  • The rewards accrued shall be at periodic intervals at rates/amounts declared upfront at the commencement of the policy

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