scorecardresearchGroup Health Insurance: What are the benefits of OPD coverage for Indian

Group Health Insurance: What are the benefits of OPD coverage for Indian employees?

Updated: 25 Apr 2023, 08:01 AM IST

Employers should provide comprehensive health insurance plans that include OPD coverage to promote a healthy work culture and protect employees from costly out-of-pocket expenses.

Having health insurance is virtually a prerequisite to lead a secure life.

Having health insurance is virtually a prerequisite to lead a secure life.

As the Indian workforce continues to adapt to new ways of working in the wake of the pandemic, employee wellness has become a top priority for companies in the last three years. The rising incidence of health issues among employees has made it necessary for companies to provide comprehensive health insurance plans that include coverage for outpatient care.

Our data shows us the following:

  • Mental illness, in particular, has become a pressing concern in recent times, with increasing work pressure, long hours, and a lack of work-life balance taking a toll on employees' mental health.
  • Our recent study revealed that over 77% of its mental health telehealth consultation bookings came from young adults aged between 21 and 30, followed by 17% from millennials aged between 31 and 40.

With the aim of making mental healthcare available to all, IRDAI has recently mandated mental illnesses to be included in regular health insurance coverage.

OPD coverage gap

Unfortunately, many employees still face high out-of-pocket expenses for routine medical needs such as mental health, skincare allergies, eye-related diseases, sleep apnea, obesity, diabetes, and respiratory problems. Although basic health insurance typically covers only hospitalisation, a significant portion of healthcare expenses arises from doctor consultations, diagnostics and medications.

The State of Employee Benefits 2023 report reveals that while 65% of India's out-of-pocket medical expenses come from out-pateint expenses, less than 2% of Indian companies offer OPD (Out-patient Department) coverage with insurance. This highlights the need for insurance coverage for outpatient care.

The current scenario of workplace and employee well-being in Indian companies

Employee attrition rate is a major concern for most companies. Employers are becoming increasingly aware that providing employee benefits is one of the ways to retain their top talent. According to a survey by the Society for Human Resource Management (SHRM), employee benefits are the third most important factor that employees consider when deciding to stay with a company.

The rising health issues among employees and their family members

Mental illness is not the only health issue plaguing employees. Skincare allergies, growing eye-related diseases, and other chronic health conditions like obesity, diabetes, and respiratory problems are also on the rise (as observed by teleconsultations on Plum telehealth).

The alarming gaps in insurance covers as part of GHI provided by employers

The lack of insurance coverage for outpatient care is a significant gap in the group health insurance (GHI) provided by employers. Basic health insurance plans typically cover only hospitalisation, leaving employees to pay for routine medical needs out of their own pockets. A recent report by Niti Aayog’s ‘Health Insurance for India’s Missing Middle’ states that a larger share of households are catastrophically impacted by out-patient expenses relative to in-patient expenses. 80% to 85% of catastrophically affected households incur OPD expenses, compared to 45% to 50% for OPD.

Current insurance plans vs the ideal insurance plan with OPD covers

Today, OPD coverage can cover treatments including dental and vision treatments, physiotherapy, doctor consultations, vaccinations, prescribed medicines and supplements, AYUSH treatments, diagnostics, and annual health check-ups. An insurance policy that offers outpatient department (OPD) benefits can help cover these expenses, making it particularly advantageous for individuals with high out-of-pocket costs or parents with young children who may require frequent over-the-counter medicines or medical tests.

Amid the current environment of uncertainty, it is essential for companies to pay attention to their employees' holistic health. The costs of healthcare in India are rising, and a single illness can drain a family's lifetime savings. Therefore, as employers, it is important to cover employees' and their families' healthcare costs and also any ancillary costs that can occur due to accidents or lifetime disabilities.

Employee health benefits should not stop at just group health insurance. Including OPD coverage in health insurance plans provided by companies for their employees is a wise decision that can benefit both the employees and the company. By providing comprehensive health insurance coverage, companies can demonstrate their commitment to their employees' well-being and promote a healthy work culture.

Abhishek Poddar is the Co-founder and CEO of Plum


85% of the respondents would consider cutting down on some luxury items so that they could spend more on health insurance
First Published: 25 Apr 2023, 08:01 AM IST