Author: Chetan Vasudeva, Senior Vice President of Business Development at Elephant.in
There is a massive transformation towards focusing on the health and well-being of people. Corporate houses, families and individuals today have a different take on health and wellness and there is an increased spending towards health and well-being of people. A recent report, evaluating investments in primary care and outpatient benefits following the COVID-19 pandemic found a 51 percent increase in companies offering outpatient department (OPD) benefits compared to 2019.
Thus, the importance of wellness and outpatient department (OPD) coverage in insurance cannot be overstated. The insurance industry too has been fast transforming to cater to the growing demand and changing consumer behaviour towards OPD and wellness. Many insurance companies are today offering insurance for consultations with doctor, dental benefits, mental wellness programs, diagnostic procedures, pharmacy benefits, physiotherapy to mention a few.
In India, 64.2% of the total health expenditure is out-of-pocket payments, mainly consisting of direct costs such as doctor’s consultation fees, medicine charges, laboratory, and other diagnostic charges. OPD coverage ensures holistic healthcare coverage by encompassing both inpatient and outpatient medical expenses, enabling individuals to avail of timely medical interventions as needed. For consumers, it is important to understand that the traditional hospitalization and surgery led insurance is not enough, given the changing trend in healthcare needs.
Consumers can claim expenses based on the specified limits outlined in the policy documents. Additionally, the OPD led benefits provide extra features such as teleconsultation coverage, unlimited online consultations with doctors, and in-clinic doctor consultation coverage. It allows in-person consultations both within and outside the service provider’s network, all up to the specified limits.
Many of the OPD insurance policies also provide diet and nutrition consultations and expert guidance on achieving a balanced diet. There are also segments around emotional wellness, which include sessions with health coaches or psychologists. Mental health today is a critical aspect of overall well-being, and its importance cannot be ignored. As per recent data, one in seven Indian suffers from some kind of mental disorder and thus mental well-being should be considered by consumers as a top-notch health insurance priority.
As organizations today are increasingly becoming vigilant about the wellness of their employees, there is increased OPD based insurance coverage and wellness programs, amongst tech and consulting industries. Employee wellness programs are becoming a crucial component of corporate wellness initiatives. These programs often encompass OPD wellness services, which include health check-ups, stress management, nutrition counselling, and fitness classes. This is a new trend, which is catching up and the OPD insurance in corporate is expected to grow at the rate of 6-7% year-on-year.
However, consumers should also be aware that there are certain exclusions for OPD benefit, as per the current industry trends. Pre-existing diseases are usually not covered, if the insured has any of them before purchasing the policy. Cosmetic procedures like cosmetic surgeries or botox related treatments are usually excluded; also experimental treatments (which is usually a rare case in healthcare practice) are also not included under OPD.
To summarize, the OPD led insurance is massively growing in the country and will create the next wave of health insurance demand and growth. It will witness huge growth in retail as well as corporate insurance. OPD coverage today is an essential component of comprehensive health insurance, which provides coverage for expenses which are more relevant for today’s consumers. Both insurance companies and consumers should be aware and look forward to providing/ availing this kind of insurance.