Health Insurance: OPD cover trend is increasing with mediclaim, trend changed after Covid

The Post-Covid-19 pandemic world has completely changed the way people think. From people's health to their finances, to the way they work, big changes have taken place in every area. Even the insurance sector has changed a lot. The corona pandemic has made people more aware of health insurance policies. At the same time, the policy structure that the consumer wants now is quite advanced.

According to industry data, the consumer no longer wants a run-of-the-mill policy that covers only hospitalization expenses. Post-COVID-19, they are more inclined to buy a holistic plan that covers OPD expenses as well. OPD includes expenses associated with a clinic, hospital or related facility for diagnosis or treatment on the advice of a medical specialist. For this the person does not need to be hospitalized as a patient.

Amit Chhabra, Head-Health Insurance, Policybazaar.com says, “An OPD cover comes with more benefits and gives you a comprehensive cover – from something as simple as fever to complex day-care procedures. Moreover, it also compensates you for those hefty pharmacy bills and diagnostic tests. All in all, these medical expenses can add up to a lot in the long run and you may suffer financial setbacks if OPD is not covered. So in today's time, it is a must-have add-on, which many consumers have already realized.'

Increased demand for OPD Coverage

As per Policybazaar data, the demand for OPD coverage is increasing rapidly. Around 15 per cent customers are now taking health insurance as well as OPD cover, a number that used to be zero earlier. This is because a regular health insurance policy covers the cost of medical care in case of hospitalization, but when it comes to expenses related to medical care, which do not include hospitalization of the patient, They are usually not covered. Industry data shows that OPDs comprise more than 70% of the expenditure in the healthcare sector. And this expense is usually borne by most of the people out of their own pocket. Also, OPD expenses were earlier not covered by health insurance policies. This meant that despite having a health insurance policy, one had to pay out-of-pocket expenses such as doctor's consultations, medicines, tests and check-ups.

As per various reports, 30-50 per cent of the total amount spent on COVID-19 treatment is spent out of pocket in case of COVID treatment. So it is natural that the consumer has become more aware of these expenses. And he wants health coverage that will cover this expense as well.

According to statistics, the most common OPD cover feature among consumers is that you can meet the doctor in person. Customers believe that this is a better option than "Digital OPD", as Digital OPD only includes doctor consultations done online, but does not include in-person consultation with the doctor.

Although the trend of taking OPD cover is more in Tier-1 and Tier-2 cities right now, the trend is gradually being seen in Tier-3 cities and beyond.

Also, most policyholders prefer cashless mode of payment where they do not have to pay anything upfront and wait for the claim to be reimbursed. Instead, they can just take the cashless route which is easier.

About 80 percent of men are opting for OPD coverage as compared to women customers. The preference for opting for OPD cover is also higher among policyholders who opt for a higher Sum Assured cover. As per the available data, generally 30 per cent of all insurance consumers opt for a health insurance cover of Rs 1 crore.

30 percent of these customers opt for some kind of OPD cover. Most of the customers opting for OPD add-on cover use the sum insured for expenses related to doctor consultation, diagnosis and pharmacy cost.

General expenses covered under OPD health cover

Consultation with a Doctor: A regular health insurance policy does not cover doctor's consultation charges. By opting for OPD add-ons, you ensure that this expense is also covered by your policy. This add-on is particularly useful in family plans, which also include coverage for children, as there is often a possibility of seeking medical advice in such cases.

Diagnostic Tests: An OPD add-on also covers the cost of the diagnostic test, irrespective of whether you are suffering from any disease or not. This applies as long as the tests are prescribed by your doctor.

Pharmacy Expenses: Expenses incurred on prescribed medicines are high but are not covered under regular health insurance plans. Along with OPD cover, these expenses are also covered by your policy.

Dental procedures and other assistance: Dental medical procedures - such as root canal treatments, fillings and tooth extractions, are not covered by a regular health policy. On the other hand, if you have opted for OPD add-on cover, not only do you get protection against the expenses incurred for such procedures, but the cost of dentures is also covered up to a specified limit. In fact, the cost of hearing aids and eyewear—like contact lenses and glasses—are also covered up to a specified limit.