Are Wellness Benefits Worth The Cost?

Kolkata-based Sumitra Dhar, 68, a homemaker, has a health insurance policy with a sum insured of Rs 8 lakh, for which she pays an annual premium of Rs 40,000. Sumitra, who hasn’t had to raise a hospitalisation claim yet, feels that the wellness benefits in her policy have proved valuable.

Her policy includes an annual preventive health check-up, teleconsultations, and nutrition counselling at no additional cost. She has used the teleconsultation facility on several occasions for minor health concerns, saving her the trouble of visiting a clinic for consultation. She has also undergone the complimentary annual health check-up, which included parameters, such as blood sugar, cholesterol and blood pressure. The nutrition consultation has been particularly useful in helping her understand how small dietary changes can support her health as she grows older.

A few wellness benefits, such as health check-ups, teleconsultations, and fitness tracking may come as an intrinsic part of some health insurance policies. Some plans may also offer 24-hour help desk and emergency facilities, such as doctor-on-call and ambulance services; in others, they may be offered as riders at extra cost. However, benefits, such as, outpatient department (OPD) consultations, medicines, diagnostics, dental care or physiotherapy may cost extra. Typically, an OPD cover is not strictly a wellness benefit, A comprehensive OPD cover usually comes with a paid rider.

For instance, an OPD+ rider offering a cover of up to Rs 10,000 for diagnostics, medicines and dental care may cost around Rs 3,000-5,000 a year, depending on the senior citizen’s age. Services, such as, physiotherapy, doctor home visits, home nursing and psychological counselling may be discounted by the insurer, with the policyholder paying the remaining cost.

The question then is if it’s worth paying extra for these additional benefits. Let’s find out.

The Benefits

Prevention: Some benefits can aid prevention. Says Siddharth Singhal, head of health insurance, Policybazaar, an insurance aggregator: “Chronic disease management programs can lead to lower healthcare costs for high-risk members. Likewise, fitness and wellness programmes can lead to lower hospitalisation rates and medical expenditure.”

In fact, the economics of prevention show up in cardiac care, too. “In our heart health claims data, hypertensive disease is majorly managed medically, with only 3 per cent of cases requiring surgery and a high-end treatment cost of around Rs 1 lakh, while an acute heart attack runs to Rs 16 lakh at the high end,” says Prayat Shah, head of healthcare, Plum, an insurtech and employee health benefits platform.

Fit and active senior citizens may also benefit from rewards linked to healthy behaviour, such as regular walking. “The Insurance Regulatory and Development Authority of India (Irdai) allows insurers to offer a premium discount or increased sum insured at renewal, based on the policyholder’s fitness regime in the previous policy year,” says Singhal. Some plans offer discounts of up to 30 per cent based on daily step counts.

Early Detection: When you are older, disease can strike anytime. Using wellness benefits like regular health check-ups and teleconsultation can help identify risks earlier and lead to effective management.

Says Renuka Kanvinde, vice president - health insurance, TATA AIG General Insurance: “Early identification of serious diseases, such as diabetes and hypertension through regular check-ups allows for timely treatments before severe health complications occur that require costly hospitalisations. Similarly, teleconsultation facilitates access to primary care through early health issue treatments, and minimises unnecessary emergency visits.”

Disease Management: Regular diagnostics, home sample collection, teleconsultations with specialists rather than general physicians, and medicine delivery are some of the benefits that work well for disease management. Says Shah: “Chronic disease management for a senior with diabetes or hypertension involves quarterly tests, consultations, and medication adjustments.”

Home-Based Care: Wellness for senior citizens involves making sure healthcare is accessible throughout their journey. Teleconsultations, digital health assessments and chronic-disease monitoring can reduce the need for frequent travel, particularly for older people with mobility issues. “As people get older, chronic conditions become more common, and their healthcare needs often change from occasional care to regular medical monitoring,” says Manish Dodeja, executive director and chief business officer, Care Health Insurance.

Wellness services, such as teleconsultations, physiotherapy, home nursing and chronic-care support, which are often offered through riders, can support day-to-day health management. Says Asit Rath, chief executive officer and managing director, Aviva India: “As healthcare continues to move beyond hospitals, home-based care and rehabilitation support will become increasingly important.”

Are They Easily Accessible?

Wellness benefits may look attractive on paper, but their value depends on how easily they can be used. When the services are available only through an insurer’s app, the technology itself can become a barrier for the elderly, who may find it difficult to download and navigate the app to book a consultation.

Dodeja says that differences in “technological literacy, technology adoption, and mobility” can affect their ability to use digital services.

The provider network is another important consideration. A discounted consultation or test may be of little use if the empanelled doctor or laboratory is located far from the policyholder’s home.

Kanvinde says that factors, such as digital literacy, hospital network, consultation limits and eligibility requirements can influence the quality of the service. So, before paying extra, families should check whether services can be booked over the phone, whether a relative can access them on the senior citizen’s behalf, the number of consultations allowed, and whether the benefit is cashless or reimbursement-based. Age limits, waiting periods, geographical ease and monetary caps should also be examined (see The Wellness Checklist).

Are They Worth The Cost?

For senior citizens, wellness benefits may have greater practical value because a large part of their regular healthcare spending happens outside hospitalisation. Regular consultations, diagnostic tests, monitoring and medicines can create a financial burden for conditions such as diabetes, hypertension and cardiac ailments. Thus, a wellness package that covers some of these expenses may prove useful, when the savings outweigh the additional premium.

Says Singhal, “Many insurers provide annual health check-ups as an add-on for a negligible premium compared to the market price.”

However, it’s worth checking and comparing prices and accessibility in your city or locality (see Wellness Benefits Worth The Cost). A person who uses only a small portion of the available benefit may end up paying more through the premium.

Nevertheless, some benefits have a more measurable financial value. “Some features carry direct financial value, such as covered annual health check-ups or renewal benefits, which are worth for comparison,” says Shah.

While wellness benefits are a valuable addition to a health plan, they should not be the only reason for choosing a policy. “The crux of any health plan is its comprehensive coverage—adequate sum insured, the right benefits, terms and conditions, waiting periods, co-payment clauses, an exhaustive list of network hospitals, and a reliable and seamless claims process,” says Dodeja. Shah says that a free check-up worth a few thousand rupees should not be given more priority over a 20 per cent co-payment clause on a large hospital bill.

Once the basics are in place though, wellness offerings can be a crucial point of differentiation.

meghna@outlookindia.com