Should you buy health insurance with OPD benefits?

Should you buy health insurance with OPD benefits?

Things you should know before buying OPD health insurance plans.

OPD plans are not predominant in India OPD plans are not predominant in India

Covid-19 has led to an increase in awareness among people towards health insurance. It is no longer considered an option but a necessity. The pandemic, however, also exposed its limitations, as a basic health insurance policy only covers inpatient expenses while excluding home treatment expenses such as doctor’s fees, diagnostic charges and homecare packages. For a country that has over 60 per cent of health expenditure being paid out-of-pocket for regular medical expenses, exclusion of outpatient expenses emerged as a major concern during the pandemic. However, to bridge this gap recently many insurers have launched OPD solutions to cover outpatient expenses such as doctor's fees, diagnostic costs, pharmacy, among other things.

For example, ICICI Lombard has recently launched a rider called BeFit, which is serviced through its ILTakeCare app. The add-on covers OPD services in a cashless manner where one can book online physical and virtual consultation by general, specialist and super-specialist doctors as well as physiotherapy sessions. The insurer has tied up with over 11,000 doctors across 20 cities. The pharmacy service covers medicine delivered at home and lab tests both at home and centre visits. The product also offers 24x7 consultations (tele and virtual) by the insurer's panel of doctors.

Sanjeev Mantri, Executive Director, ICICI Lombard General Insurance said, "The Covid pandemic has made consumers realise that health insurance does not end with having a cover just for hospitalisation expenses. What is equally important is to have a solution that encourages the practice of good health on a day-to-day basis. Our new BeFit solution addresses this part as it provides cashless and contactless solutions to customers wanting to stay fit and address their medical problems at a nascent stage, without having to reach the stage of hospitalisation."

A few of the other OPD plans in the market include Digital Care Management policy by Reliance General Insurance, Health Wallet Policy by HDFC Ergo General Insurance and Tax Gain Policy by Bajaj Allianz General Insurance.

What to look into while buying OPD plans? One of the important factors to consider before buying an OPD plan is that there should be enough network hospitals for quick consultation with the doctor. "Next is the coverage allotted by the insurance company for OPD treatment overall and per consultation charges that it should be enough for the doctor's consultation, medicine and lab test. Lastly, the facility of OPD should be available throughout the day so that in case a person needs a facility during odd hours, it should be available to them," said Naval Goel, Founder and CEO,

Another main concern with OPD plans is the cumbersome claim process, which is done through reimbursement mode. The policyholder needs to fill a form, submit bills and other required documents to claim the amount. The new plan by ICICI Lombard, however, offers cashless services where one needs to book an appointment with the doctor online post which claim can be settled through the app.

What to do?

OPD plans are not predominant in India for obvious reasons such as high premiums and it is very difficult to track them. Hence most companies don't offer OPD health covers. "There are a few health insurance companies that have started offering such plans but OPD health insurance plans are more expensive than comprehensive health insurance plans that come without OPD coverage or give as an additional rider. While a normal health care plan for a 45 year old with a sum assured of Rs 5 lakh premium comes around max Rs 12,000, the same plan would come for Rs 17,000 for Rs 2,500 OPD coverage," said Goel.

If a person is looking for complete coverage and doesn't mind paying a high premium then it can be bought as OPD coverage comes with expensive plans. "Also, in case a person has any pre-existing disease which demands a regular doctor consultation, suffering from chronic diseases, having low immunity, and higher prone to vector-borne diseases then a person can opt for an OPD cover to get financial support from a health insurance company," added Goel.

Given the changing scenario now insurers have started offering customised options in tune with the needs of the policyholder. For example, ICICI Lombard's Befit offers options ranging from only virtual consultations to both virtual and physical consultations along with pharmacy, diagnostic and physiotherapy options. The premium for a 23-year-old who wants to opt only for virtual consultation is just Rs 297 with the sum insured of Rs 6,000. Similarly for a 60-year-old person who wants the most comprehensive OPD coverage premium will be Rs 6,558 for the sum insured of Rs 55,000.

You can either buy OPD coverage as a built-in base plan or can buy it as a rider with the basic policy. Before buying, do check the coverage, exclusions as well as the network of doctors available in your area.

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