Wellness Benefit In Health Insurance

Urban lifestyles, fast-paced routines, junk food, pollution - all contribute to an unhealthy life. We have become so busy in our day-to-day life that we neglect taking care of our most important asset, our health.

But, what if you were to be rewarded for adopting a healthy lifestyle? Yes, you read that right! Insurance companies now offer health rewards called Wellness Benefits as an incentive for taking proper care of yourself.

Do all insurers provide this benefit? Are there any conditions associated with this benefit? All of these and more will be discussed in this article.

What Is A Wellness Benefit?

Wellness benefits are a type of reward offered by insurers to encourage healthy living. They offer you certain benefits or discounts if you stay in good health by -

  • Hitting the target steps in a day - When you complete a specific number of steps say 10,000 or so, insurers offer you certain benefits.

  • Undertaking any fitness or health-related activities like yoga, gym training, etc.

  • Participating in sports events like marathons, or any health event organised by the insurance company, etc.

Why Do Insurers Give You A Wellness Benefit?

Wellness benefits are a type of reward offered by insurers to encourage healthy living. They offer you certain benefits or discounts if you stay in good health by -

  • You are motivated to lead a healthy lifestyle.

  • You, a healthy insured person, will be less prone to illness or disease, so there will be fewer claims, which is beneficial to the insurer.

Wellness Benefits Offered By Insurers

The Wellness benefit option is offered by different insurers in different ways. You need to inquire with your insurer about the range of benefits offered by your health insurance policy.

The following is a list of some common wellness benefits provided by most insurers.

  • Wellness Coach

    Some insurers like Aditya Birla and ICICI Lombard provide you with a dedicated health coach who provides guidance on physical health and mental wellbeing by giving you a personalised diet chart, and exercise routine.

  • Exercise Programs And Fitness Activities

    Insurers will conduct fitness programs, such as marathons, walkathons, etc., in which you can participate and earn rewards.

  • Vaccination Drives

    Insurers like ICICI Lombard also organise vaccination drives.

  • Health Risk Assessment

    This evaluates your health and quality of life. You can check your personal lifestyle practices that may impact your health status. Different insurers conduct health assessments in different ways. For example, ICICI Lombard allows you to take an online health assessment test where you answer a series of questions about your health such as your food choice, habits, etc.

  • Preventive Health Check-Ups

    A few insurers offer free preventive health checkups to keep your health in check. Preventive health checks are routine check-ups that assess your current health status and detect illnesses early. You can use this benefit only if you undergo tests at hospitals and health centres that are part of the insurer's network.

    ICICI Lombard, for instance, provides you with a free annual health check-up coupon.

    Note: Besides these, there may also be other benefits offered by some insurers under the wellness benefit, so you should check your policy documents or ask your insurer for complete information.

Pros Of Wellness Benefits

You can use the wellness benefits to keep track of your health with the help of a wellness coach, health assessment test etc.

Some insurers like ICICI Lombard provide coupons for health checkups.

You will receive wellness points which can be redeemed for expenses like consultation charges, medicine & drugs, diagnostic expenses, dental expenses, etc. This may vary from insurer to insurer.

Some insurers provide redeemable vouchers for membership in fitness centres like gyms, yoga centres, sports clubs, etc.

Insurers like ICICI Lombard also provide you with rewards points if you successfully complete any 1 of the criteria:

Quit smoking based on your self- declaration,

Share your fitness success story,

Win any health quiz organised by them

Need Quick Support, Talk To Health Insurance Expert

How Can You Use Wellness Benefits?

As discussed before, insurers reward you for staying fit and taking good care of yourself. These rewards are given based on your lifestyle and activities. You can keep track of your health through regular preventive health checkups, following a nutritious diet, exercise regime, etc. Participating in a marathon or walkathon organised by your health insurance company can also earn you rewards.

You can redeem such rewards for -

Non-payable items

Outpatient expenses

AYUSH treatments

Payable premium from first renewal

Medicines and drugs, etc.

Guidelines Associated With Wellness Benefits

Insurers have been asked to adhere to certain regulations regarding wellness benefits as outlined in the IRDAI Guidelines released on September 4th, 2020.

The wellness or preventive regime is designed specifically for ensuring good health and thereby making health insurance affordable.

Insurers may reward you only if you adhere to wellness and preventive features criteria.

As per the Product Filing Guidelines, all wellness benefits offered by insurers must be filed and incorporated as part of the product.

There are two ways in which wellness benefits can be offered: as an optional benefit or as an add-on coverage.

Any wellness or preventive feature offered should be available to all without discrimination.

In the process of offering wellness and preventive features of the policy, any information gathered shall be kept confidential and shall not be used for purposes other than those intended.

The insurer is responsible for any errors or omissions in the calculation of accrued rewards, which will be addressed through their own Grievance Redress Mechanism.

Calculate Your Health Insurance Premium

Conditions Of Wellness Benefits

Certain conditions must be met to use this benefit. Here are some of the common conditions -

  • Can Be Utilised Only Once In A Policy Period

    You can make use of Wellness Benefits only once a year. Generally, insurers mention this explicitly in their policies. For instance, Manipal Cigna, Aditya Birla, etc., have mentioned in their policies that this will only be provided once a year.

  • Cashless Facility At Network Hospitals Or Health Centres Only

    To be eligible for cashless medical checks under wellness benefits, you must undergo tests at a hospital or health centre in the insurer's network. If you wish to avail services in a non-network hospital or health centre, you will have to submit relevant documents as requested by the insurer.

  • Available Only For Adults

    Insurers such as Aditya Birla will only offer wellness benefits to people over 18 years old.

  • The Choice Is Entirely Yours

    The decision of whether or not to opt for such a benefit is entirely up to you.

  • Benefit Cannot Be Carried Forward

    Insurers like Manipal Cigna have stated in their policy documents that rewards points earned under wellness programs cannot be carried forward to the consecutive year if they remain unused.

    Some Insurers like ICICI Lombard have mentioned in their policy that unredeemed wellness points can be carried forward for a maximum of 3 years from the date of award, provided the policy is renewed continuously for the subsequent 3 years.

  • Renew With The Same Insurer For Continued Benefits

    Manipal Cigna, for example, states in its policy documents that all earned reward points will lapse if the policy is not renewed with them.

    Besides the above-mentioned conditions, there may be other conditions that vary from insurer to insurer.

Aditya Birla ICICI Lombard Manipal Cigna

Benefits provided under the wellness program

  • Health Assessment
  • Health Returns
  • Health Coach
  • Healthy Heart Score
  • Online Health Risk Assessment (HRA)
  • Medical Risk Assessment
  • Preventive Risk Assessment
  • Disease Management Services
  • Medical Concierge ServicesAffinity to Wellness
  • Targeted Risk Assessment (TRA)
  • Lifestyle Management Program (LMP)Chronic Condition Management
  • Programs
  • Participating in ManipalCigna
  • Sponsored Programs and Worksite or
  • Online/Offline Health Initiatives
  • Health Check Up

Availability in policy year

Once No such condition mentioned in the policy Once

Is a preventive health check-up provided under the Wellness Program?

Yes Yes Yes

Is there any list enclosing the Health check-ups covered under the wellness Program?

Is there any list enclosing the Health check-ups covered under the wellness Program?

  • MER,
  • BP,
  • BMT,
  • Smoking status,
  • Blood Sugar, and
  • Total Cholesterol

Yes, the list consist of the following tests:

  • Heart related screening tests (2D echo/ TMT)
  • HbA1c / Complete lipid profile
  • PAP Smear
  • Mammogram
  • Prostate Specific Antigen (PSA)
  • Any other test as suggested by their empanelled Medical expert.
No such list provided.

Maximum limit of reward points that can be earned

You can earn up to 30% of the monthly premium. You can earn a maximum of 5,000 wellness points per insured and 10,000 wellness points per floater policy. Maximum reward points that can be earned is limited to 20% of the premium paid in the existing policy.

Show More

Need Quick Support, Talk To Health Insurance Expert

Summing Up!

Wellness Benefits offered by health insurers intend to promote a healthy lifestyle. You can use these rewards to lower your premium or cover medical expenses such as outpatient expenses, AYUSH treatment expenses etc. Thus, choosing a health insurance plan that includes wellness benefits is a wise move towards a healthier lifestyle.

The terms and conditions for wellness benefits vary from insurer to insurer. Ensure that you thoroughly review the insurer's policy wording before making a final call.

Partners - We Are Proud To Have

We have over 30+ insurance partners on our back. Rest assured, you won't be short of choices.

Why Customers Love Us?

Why Customers Love Us?

  1. We provide quick claim assistance.
  2. We are easily approachable through phone, email, and text.
  3. We are transparent operations with no hidden cost.
  4. We pursue your claims till the very end.
  5. We understand your needs, and advise most suitable insurance products to you.

Our Customers' Stories

Sharing the experience of happy and satisfied customers with you.

Sameer Yadav

I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More

Dheeraj Bhatia

I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More

Jyoti Sharma

We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More

Sumit Khanna

Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More

Kishor Kumar Bijlani

My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More

Megha Singhal

I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More