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All You Need To Know About Health Insurance Wellness Programs

Updated On Nov 06, 2020

Until recently, wellness benefits were a hallmark of premium health insurance plans. After the recent guidelines with respect to preventive healthcare and wellness, issued by IRDAI, the insurance regulator in India, these benefits could very well become a standard offering. So, what are wellness programs in health insurance?

What is a Health Insurance Wellness Program?

Health insurance products that come with benefits like membership to a gymnasium, sports club, yoga class, or rewards based on healthy living like maintaining an active lifestyle or quitting smoking are considered part of the wellness program offering. Additionally, there could be preventive healthcare benefits, like free health check-ups, a second opinion in network hospitals, etc., that are also being offered by an insurance company.

In its recent guidelines, IRDAI has directed insurance companies to make certain amendments to their rewards' benefits.

In simple terms, insurance companies would now need to do the following:

  • Provide policyholders with a summary of their rewards at least once a year.
  • Mention mode of communication of rewards clearly in the policy document
  • Mention the manner in which policyholders can redeem their benefits
  • Be responsible for any errors or omissions in the administration of the reward and resolve it through an in-house grievance redressal mechanism

Evidently, this is a welcome move wherein people are incentivized for adopting health and fitness, and insurance companies stand to gain due to lesser claims on account of improved health of their policyholders.

Also read: 5 Best Health Insurance Plans in India You Can Buy in 2020

How Does Health Insurance Wellness Program Work?

Wellness benefits can be in the form of subscription for membership or vouchers for health supplements, as mentioned in IRDAI guidelines. Insurance companies could reward policyholders in terms of renewal benefits, as well.While this could be a welcome move in promoting healthy living as envisaged by the insurance regulator, there could be cost implications that can ultimately end up in a cost increase.

Insurance companies can now define wellness benefits criteria, like different applicability for family members in case of family floater plans. They can also set eligibility and deciding criteria for wellness programs. They can choose to provide such benefits as part of the standard policy offering or as optional add-ons. They would also need to clearly convey the policy for rewards accumulation, carry forward, validity post-policy-expiry, and redemption.

How Does the Policyholder Benefit From Health Insurance Wellness Program?

The average policyholder will have more choice now. Premium memberships and subscriptions can now be accessible and affordable. Policyholders will have better visibility into the rewards program. They will also get better insurance products and better options in their wellness and preventive care offerings. A healthy lifestyle will be rewarded as an additional premium discount or enhanced sum insured.


Living healthy has its rewards. Now it is set to be financially rewarding as well. It is a win-win for everyone as overall healthcare stands to gain. As integration of wellness providers and health supplement products entail an increase in the upfront cost for insurance providers, it needs to be carefully monitored that such expenses do not get passed on to the end customer. Otherwise, it defeats the purpose.

Also read here: Top 10 Health Insurance Plans in India

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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