Insurance regulator IRDAI has issued guidelines on wellness and preventive features offered in a health insurance policy. While many insurers already offer wellness benefits to policyholders, the guidelines not only widen the scope of such features but also standardise them.
The Insurance Regulatory and Development Authority of India (IRDAI) has allowed insurers to offer this feature as an optional or an add-on cover or as a rider.
Here is what you, as a policyholder, should know about wellness features and their benefits.
What’s on offer?
Many insurers, including ICICI Lombard, Manipal Cigna, Bajaj Allianz and Max Bupa, offer health policies with wellness features that reward the policyholders for maintaining a healthy lifestyle.
Rewards are offered, provided policyholders undertake the wellness programme specified by insurers. The rewards are in the form of points which get accumulated on completion of a task, say walking 10,000 steps in a day or running 3 km a day.
So, if you have accomplished the goal, you can redeem your reward points against outpatient consultation (OPD), pharmaceutical expenses, diagnostic services and health check-ups through the network providers of the insurer (reimbursement allowed if cashless claim is not available).
Take ICICI Lombard’s iHealth Plus policy for example. You can earn 100 points if you quit smoking.
You can also earn up to 1,000 points if you undergo a medical check-up. You can redeem these points against OPD, dental expenses etc.
Similarly, in the case of Aditya Birla health plan, you can earn health returns (reward points) through accumulation of ‘Active Dayz’. If you burn 300 calories in a day, you earn one Active day.
With Bajaj Allianz General, you can redeem the accumulated points for co-pay waiver at the time of claim or increase in sum insured in case of no claim.
Note that the rewards system varies with insurers. For instance, in the case of iHealth Plus policy, the maximum points an individual can get is 5,000 and each point is equivalent to 25 paise. It can be carried forward up to three years. In the case of Manipal Cigna’s ProHealth policy, the maximum reward that can be earned is 20 percent of the premium paid and each point is valued at ? 1.
The points are monitored by health insurance companies on a real-time basis through mobile apps or wearables such as Fitbit that track your activity.
Scan & Share
As per IRDAI’s guidelines, in addition to the existing wellness benefits, insurers can also include redeemable vouchers to obtain protein supplements and other consumable health boosters, or for membership in gym/yoga centres.
Sweetie Salve, Vertical Head, Claim Medical Management, Bajaj Allianz General Insurance, says: “Redeemable vouchers, could typically have two approaches — where insurers proactively give these vouchers to policyholders on a complimentary basis, where it is offered to initiate a healthy lifestyle and create a sense of responsibility for maintaining good health, or policyholders may have to earn them based on certain wellness criteria.”
The regulator has also allowed insurers to offer discounts on premium and/or increase in sum insured based on the wellness regime.
As insurers are yet to file revised versions/new products with the regulator, it may take a while before the products are updated for the additional benefits. Despite the improved benefits, policyholders may not see a significant increase in premium.
Win-win
Amit Chhabra, Head, Health Insurance, Policybazaar.com, says: “While there could be some costs involved in offering wellness services, it would subsidise the claim cost for insurers as healthy customers would claim less.”
However, Priya Deshmukh Gilbile, Chief Operating Officer, Manipal Cigna Health Insurance, says: “The recent guidelines on wellness benefits have put in motion reward-linked wellness features for healthy living, and industry products incorporating discount and reward options might see some impact on premium.”
To enroll in wellness programmes, policyholders should purchase products that offer such benefits. All wellness benefits are offered through digital mode, through respective insurers’ mobile app. For instance, Max Bupa’s Health is an app that manages policyholders’ fitness data and health score.
Once downloaded and registered, you can sync your wearables such as Google Fit, Apple Watch or Fitbit with the mobile app; alternatively, the said app itself will track your fitness activity.
On the other hand, if you have enrolled yourself in a gym or yoga centre, where your fitness activities are done, you will still earn reward points for that as well.
iHealth Plus policy offers 2,500 points for a gym/yoga membership per year.
But do keep in mind that your policy selection should be based on coverage and not just on wellness programmes and their benefits.
