Hyderabad:
The insurance regulator IRDAI on Thursday has proposed guidelines, specifying the rewards that can be offered as wellness benefits in the health insurance products along with the requirement of disclosing in the policy contract about the manner in which the accrued benefits can be offered / utilised by the policyholders.
The IRDA has issued an exposure draft seeking comments of the stakeholders by 18th November 2019.
The new norms will cover other necessary disclosures that the insurers have to carry out for enabling informed choice to the policyholders keeping in view protection of the policyholders’ interests, said the exposure draft,
Insurers will also ensure that the service providers under wellness / preventive programs have put in place appropriate mechanism to discharge their obligations by offering the agreed services or products under wellness program of every health insurance product.Other than the monetised value of the rewards points redeemed by the policyholders, no payments shall be made by insurers to the third party merchants.
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.
Insurers shall specify the manner of redeeming the benefits allowed under the said feature in the prospectus, policy wordings and shall disclose in their website updated information, if any.
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.
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 the following:
-Outpatient consultations or treatments
-Pharmaceuticals
-Health check-ups/diagnostics
-Including discounts on all the above by redeemable vouchers.
-redeemable vouchers to obtain protein supplements and other consumable health boosters / supplements.
-redeemable vouchers for membership in yoga centres or gymnasiums for participating in fitness activities.
-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.
Insurers will 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.
Insurers will not publish the trade names or trade logos of third party merchandize in any of the insurance advertisements, but may refer the product or service offered in generic term.
However, insurers will disclose the specific items of products and services offered in their website with complete granularity and may provide a link to this in their insurance advertisement and policy contracts, provided insurers shall not promote products or services of any particular third party service provider.Insurer shall be responsible for any errors or omission in calculation of accrued benefits and shall address the same through their in-house Grievance Redressal Mechanism.