Irdai calls for wellness features in health insurance plans

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Published: November 15, 2019 12:30:35 AM

Policyholders can avail value-added benefits such as outpatient consultations and health check-ups which will help them get diagnosed at an early stage, making preventive healthcare more prevalent.

The regulator has underlined that insurers will not accept any liability towards quality of the products or services offered by the third parties.

In order to popularise wellness and preventive features in health insurance, the insurance regulator has issued draft guidelines suggesting insurers offer outpatient consultations or treatments, health check-up diagnostics and redeemable vouchers to obtain protein supplements.

The Insurance Regulatory and Development Authority of India (Irdai) has suggested that there should be no discrimination in providing any of the wellness features offered to the same or similar placed categories of policyholders of the health insurance product. Moreover, every insurer will have to assess the impact on pricing of the wellness features offered and it has to be disclosed upfront in the File and Use or Use and File application.

Wellness gains importance

The regulator has suggested that the insurers can offer discounts on premiums or increase the sum assured at the time of renewals based on the wellness regime followed by policyholders in the preceding policy period. Insurers cannot publish the trade names or trade logos of third party merchandise in any of the insurance advertisements, but may refer the product or services offered in generic term. However, insurers can disclose the specific item of products and services offered in their website with complete granularity and may provide a link to these in their insurance advertisement and policy contract.

In case of family floater plans,insurers will have to define and disclose in policy contract as to whether the accrued benefits can be carried forward when the policy is renewed with the insurers and the period of validity of the accrued benefits under both the scenarios.

Ashish Mehrotra, MD & CEO, Max Bupa Health Insurance, says that health insurance is no more just about being covered for diseases that may occur, but it has now become a part of consumers day-to-day lifestyle. “With Irdai mandating to include wellness and preventive benefits in health insurance plans, the initiative will certainly benefit both insurers and consumers. Consumers will be able to avail value added benefits such as outpatient consultations, pharmaceuticals, health check-ups and diagnostics, nutrition, yoga, gym memberships, etc., under the purview of wellness and preventive benefits. Along with benefiting the customers at large, the new inclusions will also allow insurance companies to further enhance their product portfolio,” he says.

Max Bupa introduced GoActive early last year, by partnering with healthtech firms such as GOQii, Practo, and 1mg to build a holistic health insurance plan that goes beyond hospitalisation, and can be utilised by customers on a daily basis to avail wellness benefits such as OPD, personalised health coaching, behavioural counselling, health check-ups, etc.

Similarly, ManipalCigna’s KeepActive is one amongst many wellness programmes that the company offers to policyholders to help become more active.

Quality of products

The regulator has underlined that insurers will not accept any liability towards quality of the products or services offered by the third parties. Health insurance providers will have to ensure that the service providers under wellness/preventive programmes put in place appropriate mechanism to discharge their obligations by offering the agreed services or products. The cost for the wellness services will have to be factored in the pricing of the insurance policy. Insurers will have to notify the benefits accrued to the credit of a policyholder and entitlements of the policyholders under the said feature at periodic intervals—at least once a year.

There would be a pricing impact of inclusion of such benefits in the policy. However, Mehrotra of Max Bupa says since insurance companies would source these services at an aggregate level on behalf of customers, the price is expected to be far lower than what the customers can procure from these services individually. “In the long run, use of these services should lead to better health and hence lower expenses towards treatments,” he says.

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