Page 33 - 30NOV2019EA

HEALTH

eral level needs to play an active role “ There are ticipating in fitness activities.

most large federal countries face these
The guidelines would specify the
differences across states and, in most of
important health
them, there is agreement that the fed-
ness benefits in the health insurance
in reducing inter-state inequality, by insurance and public rewards that can be offered as well-
products and the manner in which
targeting the poor in the poorest states funding efficiency and those benefits can be utilised would be
with higher funding contributions mentioned in the policy contract, as per
for healthcare through conditional or equity reasons for the draft.
unconditional fiscal transfers. introducing a standard
“If central governments play an
equalization role, it is very difficult to do benefits package n this regard, there would be
changes to wellness features and
so in the absence of a standard benefits as reference for all I benefits under the Insurance Act
package, which would set the mini- 1938. As per the draft, policyhold-
mum level of services that a country insurance coverage in ers can be provided with redeem-
wants all members of society to have, as India, says the govt able vouchers to obtain protein sup-
well as can afford and use to estimate plements and other consumable health
costs and fund allocations,” the report think tank boosters and supplements, and for
said. “In the absence of such standard- ” membership in yoga centres or gym-
ized reference and gap identification, it nasiums for participating in fitness
is impossible to judge the gaps that the high and slow-to-decrease levels of activities as part of their health insur-
central government equalization and out-of pocket (OOP) financing from ance policy.
policy facilitation roles needs to target. households accounts for more than 64 Also, discounts can be offered on
A standard benefits package also plays per cent of total health expenses in the premiums and/or increase in sum in-
a substantial role in guiding the future country. It further said that high OOPs sured at the time of renewals based on
development of commercial health are the result of ineffective risk pooling wellness regime followed by policy-
insurance. It would ensure coverage of and pre-payment systems. These are holders in the preceding policy period,
essential and insurable events under likely to remain high for the next dec- the Insurance Regulatory and Develop-
risk pooling arrangements.” ade unless substantial improvements ment Authority of India (Irdai) said.
The report also raised the issue of are made to risk pooling in the country. The draft said the costs towards the
unregulated health insurance in India. wellness services should be factored
The report stated that the standard Vouchers into for the pricing of the underly-
benefit package would be in contrast In a separate development, health in- ing health insurance product and the
to the current practice of providing surance holders may soon get vouch- cost factored should be disclosed in all
relatively shallow coverage for mostly ers for yoga centre, gymnasium mem- insurance advertisements wherever
in-patients. Thus, a standard benefits berships and even for buying protein wellness features are disclosed and
package would mitigate the effects of supplements. In its ‘Exposure Draft on promoted. “No wellness feature/benefit
the consumer blindness tendency of Guidelines on Wellness and Preventive shall be offered without it being filed or
households and the shallow coverage Features/Benefits’, insurance regulator incorporated as part of the product in
of unregulated insurance, it said. Irdai said policyholders can be offered terms of the Product Filing Guidelines,”
The absence of a minimum level health-specific services by network it added.
benefit mandate in commercial insur- providers or other empanelled hos- Further, the regulator said there
ance, the report highlighted, makes pitals for outpatient consultations or should not be any discrimination in
consumers believe they have insurable treatments, pharmaceuticals, health providing any of the wellness features/
events insurance coverage when they check-ups and diagnostics. benefits offered to the same or similarly
have, in general only, pre-payment “Based on fitness and wellness cri- placed categories of policyholders of
coverage, with substantial risk dump- teria stipulated and disclosed, insurers the underlying health insurance prod-
ing to the public sector and fiscal risk in may endeavour promoting wellness uct. “Every insurer shall assess the pric-
the short, medium and long term when amongst health insurance policyhold- ing impact of wellness and preventive
non poor consumers could afford a ers,” it said. features offered, if any, and the same
more insurable event benefits package. According to the watchdog, this can shall be disclosed upfront in the File
“Therefore, standard minimum cov- be done by offering outpatient consul- and Use or Use and File application, as
erage is also essential for the healthy tations or treatments, health check-ups may be the case, prescribed in the Prod-
development of commercial insurance and diagnostics, redeemable vouch- uct Filing Guidelines or applicable File
aligned with long term sustainability of ers to obtain protein supplements, and and Use norms,” Irdai said.
the system,” the report said. discount vouchers for membership in
According to the report, India’s very yoga centres or gymnasiums for par- LETTERS@TEHELKA.COM

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