Page 42 - Life Insurance Today January-June 2020

arriving at the reward points and corresponding in sum insured shall be independent and shall
reward points to be awarded need to be filed. not be linked to the cumulative bonus offered,
if any.
d. Wellness and preventive features under a policy
may also be offered either as optional or add-on v) Coverage of cost of treatment of any
cover. admissible claim in respect of non-payable
items that are specified under the terms and
e. There shall be no discrimination in providing any
conditions of the base policy.
of the wellness and preventive features offered and
in granting the reward points thereunder to the Provided, where more than one reward is offered,
same or similarly placed categories of policyholders choice shall be given to the policyholder to choose
of the underlying health insurance product. as per his/her requirement or need.
f. Every Insurer shall assess the pricing impact of h. Insurers shall not publish the trade names or trade
wellness and preventive features offered, if any, logos of third party merchandize in any of the
and the same shall be disclosed upfront in the File insurance advertisements, but may refer the
and Use or Use and File application, as may be the services in generic term. However, Insurers shall
case, as specified in the Product Filing Guidelines. disclose the specific items of services in their
website with necessary details and may provide a
g. Based on criteria stipulated for wellness and fitness,
link to this in their insurance advertisement and
insurers may endeavor promoting wellness
policy contracts.
amongst health insurance policyholders by offering
the following services: Provided insurers shall not promote products or
i) Health specific services provided by Network services of any particular third party service
providers or other empanelled hospitals / provider.
service providers for the following (in addition Provided further, where multiple service providers
to any such benefits already offered): are engaged by the insurers for providing benefits
a) Outpatient consultations or treatments / services, the policyholders shall be allowed to

b) Pharmaceuticals choose a service provider of their choice for
availing the wellness benefits / services.
c) Health check-ups/diagnostics
i. Insurers shall endeavour to engage multiple service
Including discounts on all the above.
providers for providing benefits / services under
ii) Redeemable vouchers to obtain health
wellness and preventive features and the list of
supplements.
service providers may be constantly expanded by
iii) Redeemable vouchers for membership in:
the Insurers. Insurers shall not accept any liability
a) Yoga centers
towards quality of the services made available by
b) Gymnasiums third parties and shall specify upfront that the said
c) Sports clubs third party is responsible for providing the services
stipulated under the wellness features and insurer
d) Fitness centers for participating in fitness
is not liable for any defects or deficiencies on the
activities.
part of the service provider. Insurers shall monitor
iv) Discounts on premiums and/or increase in sum the quality of service offered by service providers
insured at the time of renewals based on under wellness / preventive programs and ensure
wellness regime followed by policyholders in that they have put in place appropriate mechanism
the preceding policy period; provided increase to discharge their obligations provided under

Perpetual optimism is a force multiplier.

42 January - June 2020 Life Insurance Today