Health Insurers to Offer Fitness Goodies as Well?

Health insurers may soon do you some good turns by offering routine check-ups (health and dental), discounts on health boosters or protein supplements and medicines, and even help you join a yoga centre or a gym nearby.

To enjoy discounts on premium or enhanced sum insured at the time of renewal as a reward, all you need to do is follow a good fitness regime.

In order to increase the services offered in wellness and preventive features, the IRDAI (Insurance Regulatory and Development Authority of India) has released an ‘exposure draft on guidelines on wellness and preventive features.’

As per 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.”

IRDAI said that the increased sum insured must be independent and should neither be connected with the cumulative bonus that the insurers offer nor with the coverage to non-admissible or non-payable items of treatment expenses.

IRDAI says, “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.”

The Chairman, MD and CEO of Star Health Insurance, V. Jagannathan said, “This (the draft guidelines) would improve and enable the insurers to offer facilities through which better health will prevail among the insured public.”

But the insurance regulator even warned the insurers that the insurance companies will not be held responsible for the outcome of such health services as the third party authorities like hospital/gym/chain/pharmacy would offer them. The insurers are not allowed to promote products/services of any TPA in specific.

“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.”

The insurance companies can refer to the product or service offered in the generic term but are not allowed to publish the trade names or logos of third party merchandise in any insurance ad.“However, insurers shall disclose the specific items of products and services offered on their website with complete granularity and may provide a link to this in their insurance advertisement and policy contracts.”

As far as the family floater policies are concerned, insurers are required to define and disclose in the policy documents wherever wellness features are promoted. They must make it clear to the policyholders about how the accrual and redemption of benefits will be made for every member covered under the policy.