As medical expenses continue to skyrocket, rendering them unaffordable for many — the dependence on medical insurance policies has never been vital before. However, what tends to put off most policy holders is the inherent limitation of medical insurance policies of covering only hospitalisation bills, and the provision that entitles maternity-related expenses only after a long waiting period has lapsed.
However, several insurers have now widened the scope of their medical insurance policies, making them more comprehensive by including the OPD (outpatient department) cover, among other changes.
Insurance experts point out that expenditure pertaining to OPD accounts for more than 70 per cent of healthcare expenses. Being entitled to an OPD cover implies that policyholders are covered for the expenses relating to doctor consultations – physical and virtual and pharmacy, etc.
Insurers offering OPD cover include Niva Bupa whose GoActive plan gives OPD and diagnostic cover. Also, Star Health's Star Comprehensive Plan offers dental and ophthalmic cover on OPD basis. Similarly, there is Aditya Birla Health Insurance's Activ Health Platinum Essential that covers day care treatments with 586 day-care procedures which may not require 24 hour hospitalisation.
"In India, out of pocket expenses such as doctor consultations, pharmacy and lab tests expenses account for majority of healthcare costs. In order to address this concern, ICICI Lombard launched a unique rider – BeFit which is a 100% cashless OPD solution serviced entirely though our IL Take Care App," said Sanjay Datta, Chief - Underwriting, Reinsurance & Claims, Actuarial, ICICI Lombard General Insurance.
“COVID-19 has propelled the need to introduce comprehensive health insurance covers advancing the healthcare safety net. The OPD add-on cover is one such cover that will benefit policyholders to cover medical costs that don’t require hospitalisation and do not drain their savings,” said Amit Chhabra, head, health insurance, Policybazaar.com.
Even some insurance schemes have started including teleconsultation with a doctor as a part of medical insurance policy.
“Teleconsultation has been an imperative part of healthcare during the pandemic and even made its way to health insurance coverage after the guidelines by the insurance regulator,” he added.
| Insurer | Plan | OPD coverage |
| Niva Bupa | GoActive plan | OPD & diagnostic cover |
| Star Health | Star Comprehensive Plan | Dental and ophthalmic OPD |
| Aditya Birla Health Insurance | Activ Health Platinum Essential | Day care treatments with 586 day-care procedures |
Naval Goel, Founder and CEO of PolicyX.com, says, “There has been a number of additions in the form of add-ons. Policyholders will now have more optional covers to add to their base health cover which will give them more flexibility. However, all of this will come at an additional cost.”
Shorter period for maternity cover
Another development that has taken place lately pertains to reducing the waiting period for maternity cover. Maternity coverage offers protection against pre-and post-hospitalisation costs including ambulance fees.
Today, new-age policies offer maternity benefits with a waiting period as low as one year which was anywhere between 2 to 6 years earlier.
"Our flagship product offers both maternity coverage and coverage for out-patient expenses as optional covers. What is unique about the maternity benefit under Health AdvantEdge is that expenses incurred on maternity are covered after a waiting period of just 9 months," added Datta from ICICI Lombard.
Chhabra from Policybazaar says that the maternity cover even includes the expenses pertaining to the new born up to its first 90 days from the date of delivery, coverage for any medical complications and required vaccinations.
“There is a lot of innovation happening in health insurance product creation and the intent is that maternity benefits are provided at low or no cost to customers. So, for example, if a customer is getting an Rs. 25,000 maternity benefit, they are now able to get it at an affordable cost, typically less than 10-20 percent of the claim amount,” Chhabra adds.
Kapil Mehta, Co-founder and CEO of SecureNow Insurance Broker, says, “Health Insurance policies have certainly become more comprehensive. OPD benefits and lower maternity waiting periods are being introduced but these are yet to have significant impact. Specifically, OPD claims still have limited use and the extent of insurance in them is low.”
So, although one cannot get completely relieved from medical expenses regardless of the widening scope of insurance policies, but there is little denying the fact that ‘less the expense one has to incur, the lower the discomfort’.
