In some areas, such as OPD (outpatient department) cover, however, limitations remain. Owing to growing risks from environmental hazards and lifestyle diseases, people are visiting hospitals frequently nowadays for smaller medical interventions, such as consultations for minor health issues, diagnostic tests, pre-emptive check-ups, etc. At least the one-fifth of Indians who have chosen to buy health insurance don’t like to take a chance with their health, according to reports. However, these visits burn a hole in the pocket, especially of those who live in the big metros.
While day care treatments have now been integrated into most new health insurance offerings, OPD cover continues to be omitted by most flagship products. This is seen as a major irritant by the population that buys health insurance. Buyers believe that a health insurance policy should take care of every small cost they might incur on health. If they still have to pay for health issues, they become disgruntled.
The rising burden of OPD spending is making such a cover even more critical. In India, a whopping 60% of healthcare spend is on OPD treatment. The lack of an efficient mechanism and absence of a closed network structure are the chief obstacles preventing insurers from introducing worthwhile and sustainable OPD products.
A few insurers have now developed an in-built OPD feature in their health insurance policies. These include Star Comprehensive Health Insurance plan, Cigna TTK Prohealth, Royal Sundaram Lifeline Elite, Universal Sompo’s Individual Privilege Health Insurance Plan and Apollo Munich’s Health Plan.
Do OPD plans offer good value?
This is a difficult question to answer because OPD features are not priced separately but are bundled with plain-vanilla health insurance plans. This is primarily because a separately priced OPD feature doesn’t follow the principle of insurance and spread of risk, resulting in an almost 100 per cent pricing for the benefits provided. but now Root India is working this direction. For the benefit of customers here’s a snapshot of the plan comparison (See table: What is covered under OPD). The level of coverage differs from one plan to another. Some plans only cover expenses incurred on dental consultation or optical treatment in network hospitals, whereas others cover all forms of OPD. In the second table (What is covered under OPD), we have provided a brief listing of the coverage that different plans available in the market offer. The policies are for a 35-year-old male living in a metro city with no history of pre-existing diseases.
Should you buy an OPD cover?
A typical OPD plan that would provide a benefit of, say, Rs 5,000 a year is usually Rs 4,000-4,500 costlier than a normal IPD (in-patient department) plan. Therefore, the decision to buy an OPD cover depends on how frequently you may have to use these services. Typically, families with young kids or older parents who have regular minor health issues may find these plans useful, but now you have an option select OPD Treatment plan from Root India (www.rihl.in)
Rooting the OPD cover
A fairly priced Root India OPD plan that provides value to all kinds of customers can enjoy the services against pre existing or seasonal effect and normal OPD treatment too.
Insurance companies are already very expensive if OPD opted while buying the coverage. Many insurers even pay peanuts as coverage against highly inbuild premium towards OPD coverage. Root India is working in OPD direction to avoid the misleading the customers. Such plans may well become available in the market over the next two-three years. Indian customers will then reap the full benefit of OPD plans in their portfolio that are able to take care of all types of health problems they may face.