header Health Insurance

Are Wellness Benefits in Health Insurance Useful?

By Juhi Walia
10 October 2022, 11:40 AM

Maintaining one's health and immunity has always been crucial, but over the past three years of the pandemic, it has been much more crucial. However, being healthy and immune does not ensure you will never experience a medical emergency. Purchasing health insurance is a non-negotiable choice if you want to protect yourself against circumstances beyond your control.

You are being encouraged by your health insurance company to stay healthy. Did you know that staying healthy can help you renew your health insurance? Insurers follow the Insurance Regulatory and Development Authority of India (IRDAI) guidelines on preventive and wellness features by awarding reward points or health insurance premium rates on renewal. These can be used to reward policyholders who meet wellness criteria.

What are Wellness Benefits?

A policyholder who maintains good health during the policy year accrues or earns wellness benefits. However, the fitness standards may vary from one policy to the next. The requirement may be such as completing a certain number of steps, signing up for a gym membership, or getting your health evaluated. These advantages provide customers financial rewards for improving their level of health maintenance.

It could take the shape of a reduced premium, a premium waiver of the total amount, a higher sum assured, coupons, or free services at the time of renewal. These may be included as standard coverage or purchased separately. These advantages encourage people to choose health insurance, renew their policies and motivate them to become fitter and healthier. 

Wellness initiatives offered by health insurance are meant to help you get healthier. Typical components of wellness programmes include yoga sessions, gym memberships, sports club membership, etc. Insurance companies (like ACKO, for instance) typically offer alluring prices to participants who engage consistently in these activities. 

How Does a Health Insurance Wellness Program Work?

Wellness programmes for health insurance operate on a participation and incentive system. Therefore, if you participate in a wellness programme, you may be eligible to get the corresponding reward points.

The IRDAI regulations provide that wellness benefits may come in the form of membership subscriptions or vouchers for health supplements. Policyholders may also receive benefits from health insurance companies for renewing their policies. Although this might be a step in the right direction toward the insurance regulator's objective of promoting healthy living, there might be financial ramifications that lead to a cost increase. Insurance companies can now specify wellness benefit requirements for family floater health insurance policies, such as different family member application levels. They would also need to be very explicit about the conditions governing reward accumulation, carryover, validity when the insurance ends, and redemption.

What are the Benefits of Wellness in Health Insurance Programmes?

Reward Points Incentivise Healthy Behavior

Reward points may be used to receive discounts or other benefits on various medical check-up programs, such as diagnostic centers, network hospitals for healthcare facilities, pharmacy costs, etc. With the use of numerous smartphone applications with monitoring capability, insurers keep tabs on how well you manage your well-being. In essence, this is done to reward healthy behaviour and encourage a fit lifestyle through gym memberships, marathons, cyclotron rides, yoga classes, daily exercise regimens, etc.

A Wellness Coach to Help You Do it Right

Some insurance companies offer a wellness coach or mentor as part of the wellness programme. This is done to give counsel to the policyholder about things like eating the right foods, getting into an exercise routine, giving the right nutritional advice, quitting smoking, maintaining the right body weight, and many other things.

The insurers' wellness coaches provide additional support to policyholders in order to encourage them to lead healthier lifestyles. Policyholders are awarded points or other advantages for meeting the goal established for the covered during this mentorship process. The insured can later exchange these points for benefits that can be used for various medical treatments.

Second Medical Opinion Always Supports

For specific illnesses or scheduled surgeries, there are health insurance policies that offer you the advantages for expert advice and a second medical opinion. However, the insured is required to let the insurer know that she/he wants to use a second medical opinion. The standard procedure is to first seek a claim form that has been correctly submitted, along with copies of any medical documents, the investigation report, and any current prescriptions (if any). However, under the insurance plans, the insurers would not be liable for any errors or omissions brought on by e-opinions.

Get Exciting Discounts on Renewal

Policyholders are encouraged to monitor and care for their health through these types of wellness incentives. As a result, insurance companies offer premium reductions during the renewal time. However, in accordance with the most recent IRDAI guidelines, insurance companies are not permitted to offer any reimbursements for services provided by third parties other than the monetized value of the reward points. The discount price may be based primarily on the cost of prescription drugs, consulting services, or insurance premiums.

What’s Covered Under Health Insurance Wellness Programs?

In India, health insurance programs have these under an umbrella:

  • Smoking cessation programs
  • Weight-loss programs
  • Exercise programs and fitness activities
  • Stress reduction programs
  • Vaccination drives
  • Yoga classes

IRDAI Guidelines for Health Insurance Wellness Programs

Guidelines for health insurance wellness programs have been established by the Insurance Regulatory and Development Authority of India (IRDAI), which oversees Indian insurance regulations. Here is a summary; you can visit the IRDAI website for more specific instructions:

  • The sole goal of wellness initiatives should be to enhance the health of the insured.
  • Customers who consistently participate in these wellness initiatives should receive incentives from insurers.
  • Insurance companies must give everyone the chance to sign up for these programs without any restrictions.
  • Medical insurance companies ought to fix any issues that arise during the computation of reward points.
  • It is important to keep the information provided by the insured private and may only be utilised for programme purposes.
  • Every year, insurers shall provide a summary of the wellness benefit points to the relevant policyholders.

Read more - Health Insurance Norms for a More Customer-friendly 2022


In 2019, WHO declared Ischemic heart disease as the main killer on the planet. From 2 million in 2000 to 8.9 million in 2019, this disease was responsible for a rise in the number of fatalities each year. Fortunately, healthy food and regular exercise can prevent cardiac ailments.

Fitness pursuits like exercise and a healthy diet are typically included in wellness programs. You can achieve good health and prevent health problems by taking part in these. Participation can also net you enticing benefits. These can lower your health insurance premiums or offer other advantages.

Read more -


1. How does health insurance support preserving well-being and good health?

Plans for health insurance that include wellness benefits encourage the policyholder to put their health first. For establishing healthy behaviours, the policyholder is typically rewarded with points under a wellness program.

2. What is health insurance with the wellness factor?

A wellness coach is a perk provided by many insurance companies as part of a wellness program. The company assigns you a wellness coach who advises the insured on the proper diet, exercise routine, nutrition, health-related tips, etc.

3. How do wellness initiatives assist insurance companies?

Insurance companies can both save money on healthcare costs thanks to the movement in wellness benefits toward a preventative approach to health. Insurers are less likely to witness health insurance claims, reducing their expenses.

4. How do wellness programmes lower medical expenses?

A workplace health programme has the potential to target unhealthy employees in higher-risk categories while simultaneously keeping healthy employees in the "low-risk" group by encouraging health maintenance, hence reducing overall health insurance costs.

5. What's the process of a wellness program?

Wellness initiatives are more widely used than ever. Any action intended to promote better health at work and/or to enhance health outcomes is included in an employee wellness program. These programs frequently incorporate health examinations, rewards, interventions to modify behaviour, fitness programs, social support, or contests. 

Health Insurance banner
Health Insurance

Plans starting at only ₹7/day*

Enter your details to buy Health Insurance
By proceeding, I agree to the Terms & Conditions