Page 52 - Insurance Times September 2020

the wellness and preventive features offered and services in generic term. However, Insurers shall
in granting the reward points thereunder to the disclose the specific items of services in their
same or similarly placed categories of policyholders website with necessary details and may provide a
of the underlying health insurance product. link to this in their insurance advertisement and
policy contracts.
f. Every Insurer shall assess the pricing impact of
wellness and preventive features offered, if any, Provided insurers shall not promote products or
and the same shall be disclosed upfront in the File services of any particular third party service
and Use or Use and File application, as may be the provider.
case, as specified in the Product Filing Guidelines. Provided further, where multiple service providers
g. Based on criteria stipulated for wellness and fitness, are engaged by the insurers for providing benefits
insurers may endeavor promoting wellness / services, the policyholders shall be allowed to
amongst health insurance policyholders by offering choose a service provider of their choice for availing
the following services: the wellness benefits / services.
i) Health specific services provided by Network i. Insurers shall endeavour to engage multiple service
providers or other empanelled hospitals / providers for providing benefits / services under
service providers for the following (in addition wellness and preventive features and the list of
to any such benefits already offered): service providers may be constantly expanded by
a) Outpatient consultations or treatments the Insurers. Insurers shall not accept any liability
b) Pharmaceuticals towards quality of the services made available by
third parties and shall specify upfront that the said
c) Health check-ups/diagnostics
third party is responsible for providing the services
Including discounts on all the above.
stipulated under the wellness features and insurer
ii) Redeemable vouchers to obtain health is not liable for any defects or deficiencies on the
supplements. part of the service provider. Insurers shall monitor
iii) Redeemable vouchers for membership in: the quality of service offered by service providers
a) Yoga centers under wellness / preventive programs and ensure
that they have put in place appropriate mechanism
b) Gymnasiums
to discharge their obligations provided under
c) Sports clubs wellness program of the applicable health
d) Fitness centers for participating in fitness insurance product.
activities. j. Other than the monetized value of the reward
iv) Discounts on premiums and/or increase in sum points redeemed by the policyholders, no payments
insured at the time of renewals based on shall be made by insurers to the third party
wellness regime followed by policyholders in the merchants.
preceding policy period; provided increase in k. Insurers shall not receive any consideration amount
sum insured shall be independent and shall not for offering the third party services.
be linked to the cumulative bonus offered, if l. The operational costs, if any, for administering
any.
wellness and preventive features shall be factored
v) Coverage of cost of treatment of any into the pricing of the underlying health insurance
admissible claim in respect of non-payable product and costs factored shall be disclosed in the
items that are specified under the terms and prospectus or sales literature (invitation to contract)
conditions of the base policy. wherever wellness and preventive features are
Provided, where more than one reward is offered, offered.
choice shall be given to the policyholder to choose m. In case of Family Floater Plans, Insurers shall clearly
as per his/her requirement or need. define and disclose in policy document, the manner

h. Insurers shall not publish the trade names or trade in which accrual and redemption of rewards is
logos of third party merchandize in any of the considered in respect of all members covered.
insurance advertisements, but may refer the n. Insurers shall clearly specify in the policy contract

48 The Insurance Times, September 2020