IRDAI notifies wellness benefit rules for life, health insurers: Here’s what policyholders should know

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To promote wellness benefits in life and health insurance, the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines on wellness and preventive features.

Now, insurers have to notify the rewards accrued to the credit of a policyholder and entitlements of the policyholders under the wellness and preventive features, at periodic intervals but at least once in a year, as per the guidelines.

Moreover, where multiple service providers are engaged by the insurers for providing wellness benefits/services, the policyholders should be allowed to choose a service provider of their choice for availing the wellness benefits/services.

The guidelines on Wellness features issued by IRDAI on September 4, 2020, state, “As part of promoting wellness and preventive regime, insurers may offer reward points to those policyholders who comply with or meet the set criteria of wellness and preventive features.”

The regulator further said, “Wellness and preventive features under a policy may also be offered either as optional or add-on cover.”

IRDAI states the following services have to be offered to policyholders under wellness and preventive regime:

Health related services provided by Network providers or other empanelled hospitals/service providers for the following (in addition to any such benefits already offered):

  • Outpatient consultations or treatments
  • Pharmaceuticals
  • Health check-ups/diagnostics
  • Including discounts on all the above.

Redeemable vouchers to obtain health supplements. Redeemable vouchers for membership in:

  • Yoga centers
  • Gymnasiums
  • Sports clubs
  • Fitness centers for participating in fitness activities.

Also, “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,” IRDAI said.

Besides, the IRDAI reserves the right to reject wellness and preventive 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 wellness guidelines.

The other important guidelines issued by IRDAI, on September 4, 2020, are as follows:

  • There shall be no discrimination in providing any of the wellness and preventive features offered and in granting the reward points thereunder to the same or similarly placed categories of policyholders of the underlying health insurance product.
  • Insurer shall specify in the policy contract and prospectus, the mode of communication that the Insurer adopts for notification of various services offered under the wellness and preventive features.
  • Insurers shall specify the manner of redeeming the rewards accrued under the wellness and preventive features in the prospectus, policy wordings and shall disclose updated information in their website.
  • Insurer shall be responsible for any errors or omission in the calculation of accrued rewards and shall address the same through their in-house Grievance Redressal Mechanism.

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