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Health insurers!


Your health insurance policy may soon help you follow a fitness regime by offering routine health and dental checkups, offer discounts on your protein supplements/health boosters, medicines and even connect you to a yoga centre or nearby gym. If you follow the wellness regime, you could get be rewarded with discounts on premium or an increase in the sum insured at the time of renewing your policy.

In order to enhance the scope of services offered under wellness and preventive features/benefits of health insurance products, the insurance regulator-The Insurance Regulatory and Development Authority of India (Irdai) on Thursday released an ‘exposure draft on guidelines on wellness and preventive features.’
According to the proposed norms, “Based on fitness and wellness criteria stipulated and disclosed, insurers may endeavour promoting wellness amongst health insurance policyholders by offering: health specific services provided by network providers or other empanelled hospitals / service providers for outpatient consultations or treatments, pharmaceuticals, health check-ups/diagnostics including discounts on all the above by redeemable vouchers.”

“The 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,” said the Irdai.

The increase in the sum insured should be independent and should not be linked to the cumulative bonus offered by insurers or to the coverage to non-payable/non-admissible items of cost of treatment said the regulator.

“The costs towards the wellness services shall be factored into the pricing of the underlying health insurance product and price factored shall be disclosed in all insurance advertisements wherever wellness features are disclosed and promoted,” said the Irdai.

V. Jagannathan, Chairman, Managing Director and Chief Executive Officer of Star Health Insurance explained FC, “This (the draft guidelines) would improve and enable the insurers to offer facilities through which better health will prevail among the insured public.”

However the regulator also issued a caveat for insurers according to which insurance companies should not take responsibility for the outcome of such health services as these would be offered by third parties eg. hospital/pharmacy chain/gym etc. Insurers will not be allowed to promote products or services of any particular third party service provider.

“Insurers shall not accept any liability towards quality of the products or services offered by third parties and shall specify upfront that the said third party is responsible for providing the products or services stipulated under the wellness features of the product and insurer is not liable for any defects or deficiencies on the part of the service provider.”

Insurance companies have also been asked not to publish the trade names or trade logos of third party merchandize in any of the insurance advertisements, but may refer the product or service offered in generic term. “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.”

Incase of Family Floater Plans, insurers have been asked to define and disclose in the policy document and all insurance advertisements wherever wellness features are disclosed and promoted, the manner in which accrual and redemption of benefits will be made for all the members covered in the policy.

Source (The Asian Age)

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