IRDAI Draft Guidelines on Wellness and Preventive Features in Health Insurance Policy: We all know that doing Yoga, Gym or any kind of physical exercises daily improves wellness. Soon, these activities may even help in reducing your health insurance premium, or increasing the sum insured. In "Draft Guidelines on Wellness and Preventive Features/Benefits" released on Thursday, the Insurance Regulatory and Development Authority of India (IRDAI) has proposed to allow the insurers to provide "discounts on premiums and/or increase in sum insured at the time of renewals based on wellness regime followed by policyholders in the preceding policy period."
IRDAI said that the "increase in sum insured shall be independent and shall not be linked to the cumulative bonus offered, if any."
IRDAI draft has proposed several measures to make wellness, and related benefits to policyholders, an important component of Health Insurance products. It says that the insurers shall design wellness and preventive feature with the objective of maintaining good health and improving it. It proposes to allow the insurers to make following offers for promoting wellness amongst health insurance policyholders:
- Health specific services provided by Network providers or other empanelled hospitals/service providers for the following:
a) Outpatient consultations or treatments
c) Health check-ups/diagnostics
- Including discounts on all the above by redeemable vouchers.
- Redeemable vouchers to obtain protein supplements and other consumable health boosters/supplements.
- Redeemable vouchers for membership in yoga centres or gymnasiums for participating in fitness activities.
- Discounts on premiums and/or increase in sum insured at the time of renewals based on wellness regime followed by policyholders in the preceding policy period. Provided increase in sum insured shall be independent and shall not be linked to the cumulative bonus offered, if any.
- Coverage to non-payable/non-admissible items of cost of treatment.
Insurers will not be allowed to publicise the wellness service providers in any of its advertisements. "However, Insurers shall disclose the specific items of products and services offered in their website with complete granularity and may provide a link to this in their insurance advertisement and policy contracts. Provided insurers shall not promote products or services of any particular third party service provider," IRDAI said.
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The regulator will have "the right to reject wellness features proposed by the insurer if they are against policyholders' interests and are not in line with fair market conduct notwithstanding the fact that they may broadly meet with the above guidelines."
Comprehensive guidelines on wellness and preventive features/benefits
IRDAI said, "In order to enhance the scope of services offered under wellness and preventive features/benefits of health insurance products, it is proposed to issue comprehensive guidelines on wellness and preventive features/benefits. Under the provisions of Sec 34(1) of the Insurance Act 1938, it is proposed that Guidelines be issued, specifying the rewards that can be offered as wellness benefits in the health insurance products, the requirement of disclosing in the policy contract about the manner in which the accrued benefits can be offered / utilized by the policyholders and other necessary disclosures that the insurers have to carry out for enabling informed choice to the policyholders keeping in view protection of the policyholders' interests."
The regulator has asked stakeholders to share their views/comments on the draft by November 18, 2019.