by Varun Gera
Did you know that 60 to 80 percent of Indians Health care Expenses are for pharmaceutical bills, drugs and routine healthcare, not hospitalizations, consider how many times a year you or your family members are hospitalized. For an average Indian, most years pass without a hospital admission.
In contrast, the average Indian family spends much more on pharmaceuticals in a year. India has one of the highest and most burdensome expenses, which directly contributes to the high incidence of catastrophic expenses. Many people may also incur monthly medical expenses that are paid directly out of pocket. States like Maharashtra and Gujarat have higher hospitalization costs than states like Kerala, yet Kerala’s medical expenditure is 30 percent higher than these states.
Wouldn’t it be great if your insurance took care of your out-of-pocket healthcare costs? India is now on the verge of creation OPD A part of mainstream health insurance policies. OPD in health insurance will help free patients from exorbitant outpatient costs and ensure strong financial security for healthcare, increase health infrastructure and health awareness and optimize costs.
Inclusion of OPDs in insurance has a significant impact on preventive health, helps in improving the overall health quotient of the country and helps in building primary healthcare infrastructure. Generally, whenever there are new products or technologies, corporates and employees become early adopters. Cashless OPD It will help provide easy access to primary healthcare as well as financial benefits for employers and employees.
Inflation in medical expenses is currently 15 percent while general inflation is 6-7 percent. This means that medical expenses are going to be higher while our income grows at half the pace. Therefore, the need for OPD cover in our health insurance plan is the need of the hour as that is where our biggest and most burdensome expenses reside. Government intervention is the only way to stop rising healthcare costs.
what exactly There is an OPD cAbove?
OPD cover is an out patient department cover, which means coverage for expenses like doctor’s consultation fees, pharmaceutical bills, dental treatment, health check-up and diagnostic tests. Although these costs may seem small compared to hospitalization, they add up over time. Health insurance with OPD ensures additional financial security; However, OPD health insurers may have sub-limits on sum assured for expenses. An OPD insurance protects you from seemingly small, yet exorbitant expenses.
Our modern-day sedentary lifestyle comes with a variety of chronic ailments, which take a significant toll on the budget. An OPD insurance plan ensures that daily medical expenses are covered without significant financial burden. Lack of organized healthcare records also requires OPD coverage to become the norm. It allows the policyholders to get the best outpatient treatment without facing hassles due to operational defects.
Advantages of Cashless OPDs Provision for out-patient expenses
To reduce out-of-pocket medical expenses, many organizations offer their employees comprehensive OPD coverage plans that insure against doctor’s consultation, laboratory tests, hospitalization expenses, health check-ups and medicines etc. Given the comprehensive coverage of OPD schemes, employees can benefit from lower out-of-pocket expenses, which are not covered by most insurance and mediclaim policies.
Attractive tax benefits
In providing insurance cover for cashless OPDs, companies can also help employees claim tax benefits. When viewed in comparison to other health policies, plans with OPD cover are eligible for exemption under Section 80D on the entire amount of premium paid. As a result, employees, who spend huge amounts on pharmaceutical bills, or chronic patients can reduce their health care expenses with OPD cover.
Benefit of multiple claims
In recent times, many people are avoiding visiting OPD centers due to rising cost of health. However, employees with cashless OPD cover and their family members can avail multiple claims during the policy period on each visit to a doctor, diagnostic center or pharmacy. Due to their inclusive coverage, cashless OPD policies cover many types of transactions, ultimately helping to reduce financial burden and medical inflation.
Simplifying Chronic Disease Management
Many Indians suffer from chronic health conditions like heart problems, hypertension, asthma, cholesterol and diabetes. Management of chronic diseases often increases the cost of living due to expenses on check-ups, medicines and routine tests. According to IRDAI[4], 40 percent of total health claims are processed as reimbursement, which is time-consuming and costly. With cashless OPD cover, employees can visit specialist doctors, diagnostic labs, pharmacies and hospitals cashless, reducing their financial burden and simplifying chronic disease management.
Opportunity to protect savings
There is no doubt that medical inflation in India is on the rise. Employees pay out of pocket and then wait for reimbursement. The Kovid-19 pandemic has shown us that many employees bear heavy financial burdens due to lack of insurance coverage. Many families lost their entire life savings and took expensive loans to meet mounting health challenges. A cashless OPD can help employees protect their savings and maximize health benefits.
Post-Covid-19, corporate India is now more aware of how critical health insurance is. Emphasis is placed on regular health check-ups, pharmacy benefits etc. to keep employees healthy.
About 10-12 percent of Indians have a private health insurance policy. OPD expenditure accounts for 62 per cent of the total annual healthcare expenditure, but regular policies cover only hospitalization. Top-up policies for OPD cover provide some relief but are not enough to cover daily out-of-pocket medical expenses. With the threat of Covid still upon us, the cost of OPD visits is expected to increase further.
With the increasing uncertainty presented by the pandemic, employers now know that health insurance does not end with just covering hospitalization expenses. Being a side focus, OPD services are now getting more priority.
The need for primary healthcare coverage and a system that can provide health cover right from the start, even before hospitalisation, OPD services have started to gain more prominence compared to the cost of patients.
Cashless OPD is also increasing the adoption of digital platforms, where users can easily find network providers, book appointments for OPD, health tests, scans etc. and view prescriptions and reports on a single app or web page. All records in one place provide longitudinal data points of users over a larger time frame, giving better insights into users’ health profiles. This unlocks the benefits of managed care, which has been proven over time to reduce users’ overall out-of-pocket costs.
Varun Gera, Founder and CEO, HealthAsure
(Disclaimer: The views expressed are solely those of the author and not necessarily subscribed to by ETHealthworld. ETHealthworld.com shall not be responsible for any loss caused to any person/organization directly or indirectly.)
