IRDAI wellness guidelines simplified: Get reward in insurance plan for maintaining good health

Updated: Sep 19, 2020 9:02 PM

With these changes the health plans would become more inclusive which would offer you, the policyholder, increased coverage benefits and the motivation to practice healthy living.

IRDAI wellness guidelinesWith these guidelines, which came into effect immediately, all health insurance companies are being asked to include wellness benefits as a part of their product.

IRDAI wellness guidelines:  Modern-day health insurance plans have evolved from covering only the medical expenses incurred on hospitalisation to include a range of value-added benefits for policyholders. New-age health insurance plans offer the benefits of the sum insured restoration, international coverage, air ambulance coverage, coverage against robotic surgeries and much more making them suitable for modern age coverage needs. Moreover, to stay in the competition, some insurers also offer wellness and preventive health benefits to policyholders to promote healthy living.

Preventive and wellness related coverage benefits were offered in few health plans but now the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines in this respect. According to the IRDAI guidelines, health insurers are being motivated to offer wellness and preventive healthcare facilities to customers as a part of their insurance plans.

What are the benefits being pushed?

The IRDAI has asked the insurance companies to offer the following services to their policyholders –

Preventive healthcare coverage

Under this category, health insurers have been asked to offer coverage for outpatient consultations, cost of pharmaceuticals, health check-ups, diagnostic tests as well as outpatient treatments. This coverage can be offered at networked hospitals or other hospitals empanelled with insurance companies.

Health insurers can either cover these preventive healthcare costs or they can offer discounts on these costs if such costs are incurred at specified hospitals.
Wellness related benefits

Insurance companies can offer redeemable vouchers to their customers. These vouchers can be redeemed to buy health supplements or to avail a membership at sports clubs, yoga centres, gymnasiums or fitness centres.

Insurers can also provide policyholders with a discount in their renewal premiums or an increase in the sum insured on renewal if the insured follows a wellness regime during the policy tenure.

Coverage for non-payable hospitalisation costs

In the case of inpatient hospitalisation, some medical costs were not paid by health insurance policies. The IRDAI has asked insurance companies to offer coverage for such non-payable costs to policyholders as a part of their wellness programs.

The fine print

Though the IRDAI has recommended these wellness measures to be adopted by insurance companies, here’s what the fine print reads –

  • The wellness benefits offered by insurance companies should be with the objective of promoting healthy living among policyholders
  • These benefits would be offered to policyholders who meet the specified wellness-related eligibility criteria set by insurance companies
  • These wellness related benefits can be offered as an inbuilt plan benefit or as an optional add-on
  • Customers can be given the choice to choose from the wellness benefit that they need
  • The list of service providers proving wellness related benefits to policyholders should be clearly stated in the insurance company’s website
  • For family floater plans, it should be clearly stated if the wellness benefits would apply to all members or not
  • The terms regarding carrying forward of wellness benefits to the next policy year, if not used in the current year, should be clearly stated

What’s in it for you?

Till now, some health plans offered discounts on premiums based on the number of steps you took in a policy year or if your annual medical check-up report was found favourable. Many plans also offered wellness-related discounts for promoting healthy living. However, the benefits were restricted to a handful of insurance companies only.

With these guidelines, which came into effect immediately, all health insurance companies are being asked to include wellness benefits as a part of their product. This has been done to –

  • Make policyholder conscious about their health
  • Motivate the insured members to maintain a healthy lifestyle
  • Reward policyholders for their efforts in maintaining a good health
  • Make health plans more wellness-oriented

Overall, this welcome move by the IRDAI would make India healthier and reduce the burden of diseases on Indians. Today, like ‘organic’, ‘vegan’, ‘Zumba’, ‘Pilates’, ‘Yoga’, etc. have become common in an average millennial’s vocabulary, this move would make health plans more in sync with the current trend of healthy living. With these changes the health plans would become more inclusive which would offer you, the policyholder, increased coverage benefits and the motivation to practice healthy living.

By Dhirendra Mahyavanshi, Co-Founder, Turtlemint (an InsurTech Company)

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