Money & Banking

Your health insurance cover will soon offer wellness and preventive benefits

G Naga Sridhar Hyderabad | Updated on November 09, 2019 Published on November 08, 2019

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IRDAI spells out draft norms for wellness, preventive benefits

When you buy health insurance, you may as well look of wellness and preventive care services soon.

The Insurance Regulator and Development Authority of India (IRDAI) intended to permit health insurance companies to come with additional services.

According to the draft guidelines on wellness and preventive benefits health insurance policyholders issues released by IRDAI, health cover polices could come up with wellness and preventive features as they help in keeping oneself in good health as well as improving it.

The health insurers will have to offer these benefits by incorporating them as part of the main health plan at the time of filing product approvals from the regulator.

"No wellness feature/benefit shall be offered without it being filed or incorporated as part of the product in terms of the product filing guidelines,’’ the draft says.

Read: How the IRDAI-proposed higher loss limits will benefit customers while filing insurance claims

The benefits should be also be uniformly offered to all those who by a simlar policy without any discrimination.


One the final guidelines are brought in probably in a couple of months, a policyholder can look for specific health services such as outpatient consultations or treatments, pharmaceuticals and health check-ups/diagnostics.

As health insurers will not have original expertise in these areas they can source them from network providers or other empanelled entities.

You will have to pay for these features, of course. The regulator expects individual insurer to asses the pricing impact of wellness and preventive features to be offered. A prior approval of IRDAI is a must before fixing the pricing.

"The costs towards the wellness services shall be factored into the pricing of the underlying health insurance product,’’ it said.

The price factor should be also be made public in all insurance advertisements wherever wellness features are disclosed and promoted.

How does it help?

According to Sanjay Datta, Chief, Underwriting, Claims, Actuary, Reinsurance, ICICI Lombard, providing wellness and preventing benefits ``augurs well for the health of the individual as well as industry.’’

"Preventive measures works very well in any portfolio for insurers. Policy holders will surely see value in them as they can avoid hospitalisation whenever possible,’’ he told BusinessLine.

"The cost of diagnostic services has been increasing in some key ailments. Including them in health cover may provide some cushion. But we need to see how public responds in a market like India. It may take time to catch up,’’ said a senior official of public sector general insurance company.

According to IRDAI data, With a market size of Rs over Rs 37,000 crore, health insurance has been growing at over 20 per cent per annum for the last three years mainly driven by govt- led health insurance schemes and increasing awareness.

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Published on November 08, 2019
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