Explained: The Importance Of OPD Cover In Group Health Insurance Policy
Out patient treatment, commonly referred to as OPD, is a medical department where basic cases that do not necessitate that the patient gets hospitalised are treated.
OPD treatments encompass doctor’s consultation charges and short treatments that can be completed without getting admitted to the hospital. In fact, all the hospitals are equipped with a dedicated out-patient department that offers a wide range of services, including diagnosis of ailments, medical tests, minor procedures, and follow-up visits after hospital discharge.
With so many benefits and widespread facilities of the department, why have OPD plans not been predominant in India? The major reasons OPD plans are not predominant in India are due to high premiums and the difficulty with authenticating bills, making the claim settlement procedure lengthy.
In a country where out-of-pocket medical expenditures account for 62 per cent of all healthcare costs in India, the exclusion of outpatient costs has emerged as a grave concern, especially more since the onset of the pandemic.
However, to meet the rapidly rising market demand, many insurers are now introducing OPD services to cover outpatient expenses like doctor’s consultation charges, diagnostic costs, and pharmacy among other things. Keeping in mind the growing sedentary lifestyle and increasing healthcare costs, it is a wise decision for employers, too, to opt for group health insurance plans with OPD coverage for employees.
Benefits of Group Insurance with OPD Cover
1. Group health insurance covers are explicitly customised to suit the needs of the organisation and its employee and their families. In most cases, the premium is entirely or majorly paid by the employer on behalf of employees, which allows them to avail of tax benefits.
2. Depending on the specific needs of an employer, certain OPD features are modified in the health cover, such as online doctor consultations, mental wellness, and digital fitness programs.
3. Owing to high volumes, health insurance companies facilitate OPD benefits to employers at subsidised rates, which encompasses a list of inclusions, such as discounted OPD consultations, discounted lab tests, exclusive dental services, discounted medical bills, and OPD treatments. Many insurers also offer complimentary benefits like giving access to unlimited fitness classes or in-app videos and podcasts on mental health.
4. As advantageous group health insurance with OPD cover is for employers, employees too can reap the benefits. For instance, if the employee is required to undergo a preventive health check-up and shell out the expense for it from their own pocket, they are entitled to a tax exemption of the entire amount. If the expense is made for self/spouse or children who are financially dependent on the policyholder, the maximum limit is Rs 5000. Likewise, if the expense is directed towards dependant senior citizen parents, the amount can go up to Rs 50,000.
Employers can either purchase OPD coverage in the form of a built-in base plan or take it as a rider with a basic health insurance policy. Before investing in either of these options, it is imperative to check the extent of coverage offered, exclusions of the OPD cover, and network of hospitals and clinics available in the plan.
Conclusion
A group health insurance policy offering OPD coverage is essential for employees in today’s times to ensure they are safeguarded against exorbitant medical expenses. As an employer, you can also consider investing in top-up cover with your standard group health insurance policy for OPD. Group insurance with OPD coverage can help an employee seek the best outpatient treatment without spending excessively from their own pocket.
