These days, many health insurance plans are accompanied with wellness benefits which reward the policyholder for maintaining a healthy lifestyle. Insurance companies offer various benefits under the health insurance plan through wellness programs associated with the health insurance plan. Most of the wellness programs are usually offered as a value added benefit, and there is no additional cost associated with opting or enrolling for these benefits or programs.
As per IRDAI’s Health Regulations, 2016 insurers can offer wellness programs to their policyholders through various incentives and mechanisms which should be explicitly mentioned in the brochure and policy document. No discount on any third-party service or merchandise is allowed, but discounts in premium, discounts on consultation services, discounts on pharmaceuticals may be allowed.
Kinds of Wellness Benefits at a glance:
Many insurance companies under a wellness program offer the benefit of a Wellness Coach where the company assigns you a wellness mentor who guides the insured about the right kind of diet, fitness regime, nutrition, health related tips, etc. With wellness coach, the policyholder can avail mentoring in areas of weight management, nutrition, fitness, tobacco cessation, etc. These coaches are available in the form of wellness experts associated with the insurer, chat service, mobile app, etc.offering an expert support to lead a healthy life.
On attainment of a specified target under the wellness program, during the wellness journey of the insured,he/she is rewarded with various benefits or points.Such rewards may range from offering discounts/ concessions on various diagnostic centers, network hospitals to avail health care services, discounts on pharmacy bills, OPD bills, etc.
Another major advantage comes in the form of discounts on renewal premiums by redeeming reward points for leading a healthy lifestyle. Healthy lifestyle may include participation in activities like a marathon, cyclothon, practicing yoga, routine workouts, regular walking, etc. as per the terms and conditions specified in the health plan.
Insurers keep track of your health activities through various digital devices,mobile apps, allowing an integrated tracking mechanism.
Examples of Health Plans offering Wellness Benefits:
• Cigna TTK offers ‘Health Coach’ program under its “ Pro active Living Program,” which helps in assisting customers to manage their pre-existing chronic conditions such as diabetes and hypertension.
• Aditya Birla Health Insurance company offers the benefit of wellness coach under its wellness programs.Aditya Birla Health Insurance plans also offer wellness programs as ‘Health Returns’ where the policyholder is entitled to earn reward points on each ‘active day.' A 30-minute workout at an empaneled gym or walking 10,000 steps in a day qualifies for recording an ‘active day’.
Many health insurance plans also offer expert advice and second medical opinion benefit for specified Illness / planned Surgery / surgical procedure from the medical practitioners empanelled with the insurance company. The policyholder has to inform the insurer about availing the second opinion at the time of need. The insured has to submit a duly filled claim form along with the copy of all medical reports, including investigation reports and discharge summary (if any).However, insurers don’t cover any liability arising due to any errors or omission or representation or consequences with regard to the e-opinion under the health plans.This benefit can be usually availed once in a policy year or as specified in the policy conditions.
Apollo Munich’s Optima Restore, Cigna TTK Pro Health Insurance, Max Bupa Heartbeat are some of the plans offering medical second opinion benefit under the health insurance plans.
Cost of availing Wellness Benefits
Such wellness benefits are complimentary benefits and no additional premium is charged to avail these benefits.The premium for plans offering such benefits is quite competitive in the industry and does not attract higher premiums as compared to health insurance plans without wellness benefits.
Mutually Beneficial for Insurer & Insured
A healthy person who is insured is good for himself and also for the insurance company. By introducing wellness and disease management programs under wellness feature ensures that the policyholders taking up such programs are less likely to claim under their health insurance policy.With the insured following a healthy lifestyle under the wellness program offered by the insurance company, there are less chances of illness or disease related claims under the policy.
Also,the insurance regulator no longer allows the insurance companies to terminate a health insurance policy midway due to recurring claims under a health insurance policy.
Such benefits are beneficial both for an insurer and the insured. To avail the benefits or discounts under the wellness benefits, the insured has to work out by keeping him/her physically active and fit. Such wellness programs motivate the insured to stay fit to reap the wellness gains under his health insurance plan.
Word of Caution
It is important not to get carried away with the discounts and benefits offered under the wellness programs under your health plan. Not all health plans will offer you homogeneous wellness benefits. The terms and conditions associated with wellness benefits vary from insurer to insurer based on the wellness programs offered under their health insurance plans. It is utmost important to check the key policy benefits,policy coverage, claim settlement ratio, claim settlement process of the insurer too before making a final decision.
The author, Harjot Singh Narula is Founder & CEO, Comparepolicy