S Prakash, CEO – Health Insurance Ecosystem and Strategic Partnerships at the General Insurance Council, said that the current model, largely built around financing hospital treatment, is proving insufficient.
Rising lifestyle diseases, more complex treatments, and growing health awareness are pushing insurers to rethink how policies are designed.
“The shift is not about adding wellness as an extra feature, but about moving from ‘illness cover’ to ‘wellness cover’,” Prakash said.
How the model could change
At the core of this transition is preventive care, early screenings, continuous monitoring, and structured wellness programmes aimed at reducing the likelihood of hospitalisation in the first place. Instead of episodic interactions during claims, insurers may engage with policyholders throughout their health journey.
Technology is expected to play a central role.
Platforms such as the National Health Claims Exchange (NHCX), along with data analytics, could enable real-time sharing of health information, risk assessment, and early detection of potential issues.
This, in turn, may allow insurers to design more targeted interventions.
However, Prakash noted that preventive care must be outcome-driven.
“It cannot remain activity-based or participation-led; it has to show measurable improvements in health,” he said, flagging the risk of misuse if benefits are not designed carefully.
Why current ‘wellness’ features may fall short
While many insurers already offer wellness benefits, such as annual health check-ups or fitness-linked rewards, these remain limited in scope.
According to Prakash, such measures often fail to address the underlying causes of chronic conditions.
A more evolved approach would involve continuous, personalised programmes focusing on nutrition, exercise, sleep, and mental health, supported by wearables and AI-led insights. Crucially, incentives may also shift—from rewarding participation to rewarding measurable health improvements, such as better metabolic indicators, he said.
Can preventive care lower costs?
From a consumer perspective, preventive-care-linked insurance may help reduce long-term healthcare costs, but not immediately. Its impact depends on whether individuals act on early warnings and sustain lifestyle changes.
Prakash described preventive care as a “long-term cost stabiliser,” particularly relevant as medical costs rise. However, he cautioned that routine check-ups alone offer limited value without follow-through.
What stands in the way
Despite growing intent, the industry’s transition to a wellness-led model is still evolving. Most offerings remain fragmented, and key building blocks, such as standardised data systems, interoperable platforms, and closer coordination between insurers and healthcare providers, are still being developed.
Insurers are also required to demonstrate that wellness programmes lead to tangible health outcomes, not just higher engagement levels.
A look at some of the health plans with wellness or preventive features
| Insurer/plan | Key wellness features | Type of approach |
| Aditya Birla Health – Activ One | HealthReturns incentives, fitness-linked rewards, preventive check-ups | Outcome + behaviour-linked wellness |
| Care Health Insurance – Care Supreme | Annual health check-ups, wellness benefits, modular add-ons | Preventive + modular design |
| Bajaj Allianz – Health Guard | Preventive check-ups, discounts/benefits tied to health engagement | Basic wellness integration |
| Niva Bupa – Health Plus | Health check-ups, preventive care coverage, lifestyle support features | Preventive care focused |
What policyholders may need to watch
For now, consumers looking to benefit from this shift may need to take a more active approach while choosing policies.
Experts suggest evaluating plans that offer continuous engagement, personalised wellness support, and incentives linked to measurable outcomes, rather than basic activity-based rewards.
At the same time, such comprehensive plans may come at a higher cost currently, given the investments required in technology and healthcare integration.
