Wellness Benefits in Health Insurance

What are Wellness Benefits in Health Insurance?

Wellness benefits in health insurance are additional features designed to promote a healthier lifestyle and encourage proactive health management. These benefits include incentives for engaging in activities such as regular health check-ups, joining fitness programs, running, cycling, etc. By participating in these programs, policyholders can improve their overall well-being, lower their risk of developing chronic conditions, and potentially enjoy better health outcomes.

The significant advantage of wellness programs in health insurance is the financial benefit they offer. Many health insurance companies in India provide discounts on premiums or renewal costs as a reward for actively participating in wellness programs. This makes prioritising your health not just physically beneficial but also financially rewarding.

How do Wellness Benefits Work in Health Insurance?

Typically, preventive health and wellness benefits are available in the form of wellness or reward points under mediclaim insurance plans. The insurer rewards the policyholder with points for staying fit and leading a healthy lifestyle. The policyholders can redeem these points to avail services offered by empanelled service providers or to get discounts on the renewal premium, pharmacy bills, consultation fees, etc.

Insurers track the progress of policyholders using digital tools & applications and grant rewards periodically or annually based on milestones. For example, some insurers reward wellness points if the insured completes a fixed number of steps every day.

List of Common Wellness Benefits in Health Insurance

Check out some of the most common wellness benefits offered by health insurance providers in India:

1. Preventive Health Check-ups

   Several health insurance providers offer preventive health check-up facilities as part of their wellness benefits. Policyholders can get these check-ups done at any of their network service providers, which are available free of cost or at a discounted price. These check-ups allow policyholders to monitor their health and detect any health condition or disease at an early stage.

2. Discount on Healthcare Services

   Many health insurance plans offer discounts on healthcare services such as diagnostic tests, pharmacy bills, OPD consultations, etc., as part of their wellness benefits. These discounts can be availed at a network hospital or service provider of the insurance company. Moreover, they also offer redeemable vouchers that can be used to buy health supplements.

3. Personal Wellness Coach

   Most mediclaim insurance policies provide a personal wellness coach to policyholders as part of their wellness benefits. The coach acts like a personal mentor and helps policyholders adopt a healthy lifestyle by suggesting a personalised course to achieve various health goals. In fact, the coach sets a realistic target for the policyholder to make a lifestyle change, and the redeemable wellness points are rewarded when the policyholder achieves the set target.

4. Access to Health Maintenance Services

   Policyholders can also earn wellness points to earn a discount on health maintenance services. They can redeem these points to get a membership of various wellness centres, such as gyms, sports clubs, yoga centres, fitness centres, etc., at a discounted price.

5. Discounts on Renewal Premium

   Health and wellness points can be used to reduce the renewal premium of the health insurance policy. While some plans allow policyholders to reduce their premium for up to a fixed limit, others enable them to save up to 100% on the premium amount if they earn a certain number of points.

6. Second Medical Opinion

   Some mediclaim plans offer a second medical opinion to policyholders as part of health and wellness benefits. It enables policyholders to get a second opinion from a qualified medical professional for any critical disease or severe medical condition. The best part is that the policyholder does not have to pay for the consultation fee as it is taken care of by the insurance company.

Benefits of Wellness Programs in Health Insurance

Here are the top benefits of health insurance wellness programs:

• Encourages a Healthy Lifestyle: Wellness programs often include fitness classes, health check-ups, diet consultations, etc., motivating individuals to maintain a healthier lifestyle and reduce the likelihood of chronic illnesses.
• Rewards for Healthy Behaviour: Many insurers offer incentives or rewards such as premium discounts or reward points for participating in health activities like regular exercise, health assessments, or achieving specific health goals.
• Early Detection of Health Issues: Regular screenings and check-ups as a part of wellness programs help identify potential health concerns early. This further prevents them from escalating into more severe conditions.
• Cost Savings on Healthcare: By encouraging preventive care, wellness programs reduce the frequency of expensive medical treatments, thereby reducing out-of-pocket expenses for policyholders.

IRDAI Guidelines for Health Insurance Wellness Benefits

The Insurance Regulatory and Development Authority of India (IRDAI) has issued the following guidelines to regulate wellness programs offered under health insurance plans.

• Wellness programs by insurers should solely aim to encourage healthy lifestyles.
• Wellness benefits may either be a part of the main health plan or provided as an add-on.
• Only eligible policyholders, as per the wellness program criteria, can enjoy the benefits.
• For family floater health insurance plans, insurers should specify if all insured family members can access wellness benefits.
• If the insurer collaborates with various service providers for wellness programs, policyholders should have the freedom to choose their preferred service provider.
• The insurer must clearly list all service providers offering wellness programs on its website.
• Insurers should outline rules about earning, using, or carrying forward wellness rewards in case they are not used during the policy year.
• Clear instructions should be provided on how to redeem these wellness benefits.
• Insurers must inform policyholders about their earned wellness rewards at least once a year.
• Any personal information shared by policyholders for wellness programs must remain confidential and used only for this purpose.