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Group OPD and Wellness

Group mediclaim OPD and wellness is a health plan that provides coverage for outpatient consultation and wellness charges under a group health insurance policy. It is available as an add-on cover that has to be purchased over and above an existing group health insurance policy. It can be availed at the health insurance company’s specified network of service providers in a cashless manner.

Features of Group Mediclaim OPD and Wellness Plan

Following are the unique features of OPD and Wellness cover for Group Mediclaim policy:

  • Available for people with group health insurance

  • Covers outpatient department (OPD) fee and wellness charges

  • Purchased as an add-on cover only

  • Provides cashless payment option

  • Covers physical consultation, teleconsultation & e-consultation

Types of Plans under Group Mediclaim OPD and Wellness

Three types of coverage plans are available under the Group mediclaim OPD and wellness cover. They are:

  1. Good Health+ - Good Health+ is a customized group OPD plan that provides coverage against medical expenses arising out of outpatient consultations, dental treatments, diagnostic tests, pharmacy expenses and vaccinations.

  2. Care Well - Care Well is a non-selective group OPD plan that provides coverage against health expenses incurred on outpatient consultations, health check-ups, pharmacy expenses and teleconsultations. It also provides the group members with saving options in the form of ‘Discount Connect’ to reduce their healthcare expenditure.

  3. E-Consultation - E-Consultation is a group health plan that provides coverage for online consultation fees charged by medical practitioners, such as a general physician, orthopaedic, gynaecologist, paediatrician, cardiologist, dermatologist and diabetologist among others. It allows the insured to avail online consultations through phone chat, voice call and video call.

Group Mediclaim OPD and Wellness Plans at a Glance

Categories

Good Health+

Care Well

E-Consultation

Minimum Entry Age

Children - 91 days

Adults - 18 years

-

Children - 91 days

Adults - 18 years

No of Family Members Covered

Up to 4/ 6 members

Up to 6 members

Up to 6 members

Cover Type

Floater

Floater

Individual/ Floater

Minimum Employees

7

-

15

Co-Payment

10% of sum insured

10% of sum insured

-

Good Health+

Good Health+ covers the daily or routine healthcare needs of a person insured under group health insurance up to the limit of the wallet. It offers sum insured of a minimum of Rs 7,500 to a maximum of Rs 2 lakh.

Coverage Under Good Health+ Plan

Good Health+ provides coverage for the following health expenses:

  • OPD Consultation - It covers the expenses incurred on taking physical outpatient consultation with a medical practitioner, which does not require the insured to get hospitalized. It includes consultations taken by a general physician or a medical specialist. It does not cover consultations taken through homeopathic doctors.
  • Diagnostic Tests - It covers the cost of diagnostic tests that have been prescribed by a doctor. For example, X-rays, ultrasound, blood test, etc. It does not include tests conducted for the purpose of preventive health check-ups.
  • Pharmacy Expenses - It covers the cost of medicines that have been prescribed to the insured by a doctor. Under some plans, pharmacy vouchers may be given to the insured.
  • Dental Procedures - It covers the medical expenses incurred on dental procedures, such as root canal treatment, root amputation, extractions, tooth X-rays, etc. It does not cover the cost of any cosmetic procedure undertaken by the insured member.
  • Vaccination - It covers the cost of all vaccinations prescribed by a doctor or recommended by the World Health Organisation (WHO). This benefit is only available for insured children up to the age of 10 years.

Care Well

Care Well covers regular healthcare needs of an individual insured under a group health insurance policy up to the limit mentioned for each coverage benefit. Care Well is available under two sub-plans - Care Well Basic and Care Well Advance. Each sub-plan offers three coverage options for the insured employee/ group member to choose from.

Coverage Under Care Well Plan:

Care Well provides coverage for the following healthcare expenses:

  • OPD Consultation - It provides coverage for OPD charges incurred on taking outpatient consultation with a medical practitioner, including general physician and medical specialists. It does not cover the cost of OPD consultation taken by a homeopathic doctor. While the Care Well Basic plan covers consultation fees up to Rs 2000, the Care Well Advance plan comes with a coverage limit of Rs 3000.
  • Pharmacy Expenses - It covers the cost of medicines prescribed by a medical practitioner. The medicines cost will be covered on the sum insured or voucher basis. The Care Well Basic plan covers pharmacy expenses up to Rs 500, while the Care Well Advance plan covers medicines up to Rs 750.
  • Health Check-Ups - It covers the medical expenses incurred by the insured on getting regular health check-ups. Every member is eligible to undergo health check-up under this cover. Moreover, Care Well also offers the facility of home sample collections for tests at over 40 cities across the country. The Care Well Basic plan covers 30 parameters, comprising of lipid profile, liver profile, kidney profile, iron deficiency and thyroid profile. In addition to these parameters under the Basic plan, the Care Well Advance plan covers 63 parameters that also includes complete hemogram, diabetic screen including Hba1c, vitamin profile D & B12 and testosterone.
  • Teleconsultation - It offers medical consultation with a general physician over the telephone and covers the charges involved. The insured member can take unlimited teleconsultations during a policy year.
  • Discount Connect - It provides the group members with saving options to lower the expenses incurred at network providers of the insurance company. The saving options can be used on OPD consultations, OPD procedures, diagnostic tests, radiology services, pharmacy expenses, health check-ups, etc. Discount Connect comes with a subscription of one year.
  • Consultation

E-Consultation comes with both selection and non-selection option. It is available for a policy tenure of one year but has lifelong renewability. For every e-consultation, an online prescription will be provided to the insured. Besides, an insured member can take an unlimited number of e-consultations during the policy year.

E-Consultation offers six types of subscription plans that are illustrated in the table below:

Subscription Plan Type

Coverage

Plan 1

General Physician only

Plan 2

General Physician + Mental & Emotional Well Being

Plan 3

General Physician +Endocrinologist/ Diabetologist

Plan 4

General Physician + Homeopathic Physician + 7 Specialists comprising of Internal Medicine, Gynaecologist, Orthopaedic, Paediatrician, Dermatologist, Ophthalmologist and Nutritionist

Plan 5

General Physician + 10 Specialists comprising of Internal Medicine, Gynaecologist, Orthopaedic, Paediatrician, Cardiologist, Dermatologist, Ophthalmologist, Nutritionist, Psychologist and Sexologist

Plan 6

General Physician + Homeopathic Physician + Specialist comprising of Obstetrician & Gynaecologist, Orthopaedic, Paediatrician, Endocrinologist/ Diabetologist, Cardiologist, Pulmonologist, Dermatologist, Nephrologist, ENT Specialist, Neurologist, Gastroenterologist, Nutritionist/ Dietician, Psychologist and Psychiatrist

Eligibility for Group Mediclaim OPD and Wellness Plan

Take a look at the eligibility criteria of OPD and Wellness plan for Group Mediclaim policy:

  • Adults between 18 years to 60 years can purchase this plan. Senior citizens, such as parents and parents-in-law, can be covered up to 80 years.
  • Children from 91 days to up to 18 years can be covered
  • A maximum of six family members comprising of self, spouse, daughter, son, father, mother, father-in-law and mother-in-law can be covered.

Who Cannot Buy Good Health+ and Care Well Plan?

The following people cannot buy Good Health+ and Care Well plan:

  • Contractors
  • Temporary/ Seasonal/ Substitute/ Uncompensated employees
  • Volunteers
  • Silent Partners
  • Shareholders/ Investors
  • Non-active, temporary, freelance officers or managing members of the group/ company

Health Insurance Companies Offering Group OPD and Wellness Cover

The following table shows the health insurance companies that offer OPD and wellness covers under their group health insurance plans:

Health Insurance Companies

Group Health Insurance Plan

Special Features

Inclusions

Exclusions

(Applicable on OPD and Wellness Cover)

Aditya Birla Health Insurance

Aditya Birla Group Protect Plan

-  Second hand opinion available

-  Multiple add-on covers

-OPD expenses, including physical consultation/ tele-consultation/ e-consultation, diagnostic tests and pharmacy expenses

-Cancer secure cover

-Income protect

-Heart secure cover

-Emergency road accident cover

-Credit protect (in case of accidental death/ permanent total disability)

-In-patient hospitalization

-Day care treatments

-Naturopathy treatments

-CT scan & MRI scan

-Dental treatment

-Cost of dentures and artificial teeth

Digit Health Insurance

Digit Group Total Protect Plan

-Limited wellness benefit

-Multiple add-on covers

-OPD benefits, including consultation fees, diagnostic procedures, minor surgical procedures, dental treatment and fracture cover

-Accidental death

-Permanent total disability

-Loss of income

-Children education & marriage expense benefit

-Trauma counselling

-Domiciliary hospitalization

-Miscarriage due to accidental injury

-HIV cover

-Cost of hearing aids, spectacles, contact lenses, implants

-Cost for vaccination except for an animal bite

-Cosmetic procedures

-Ambulatory devices, such as BP monitors, walkers, thermometres, glucometers

-Dietician fees

-Vitamins and supplements

HDFC ERGO General Health Insurance

HDFC ERGO Health Comprehensive Suraksha - Group Plan

Offers additional wellness benefits, such as:

-Fitness discounts at renewals

-Health incentives

-Wellness services, including saving options on OPD, pharmacy and diagnostic tests; health coach, specialized health care programmes

-Critical illness cover

-Women Suraksha

-Sachet critical illness

-Recovery benefit, including mental health care

-Hospital cash

-Optional covers including preventive health check-up, second medical opinion, loss of income, pre-diagnosis cover, post-diagnosis assistance

-Newborn baby cover

-Obesity & weight control programs

-Cost of vaccination except for an animal bite

Kotak Health Insurance

Kotak Group Health Care Plan

-Pre-existing disease waiting period waiver

-Special provisions for insured senior citizens

-OPD dental treatment

-OPD vision care

-Second e-opinion cover

-Maternity benefits

-AIDS/ HIV cover

-Psychiatric & psychological care

-Wellness programmes, including health check-up & report evaluation, health risk assessment (HRA), medical centre management, diet & nutrition plans, health camps & expert sessions, lifestyle/ wellness management programs (maternity well-being, quit smoking program, etc.)

-Plaque control

-Oral hygiene & diet

-Sunglasses/ contact lenses that are not prescribed by ophthalmologist/ optometrist

ManipalCigna Health Insurance

ManipalCigna Lifestyle Protection - Group Plan

-Well-designed wellness cover

-Survival period waiver

-Worldwide coverage

-Accident death benefit

-Permanent total / partial disability

-Temporary total disability

-Medical second opinion

-Wellness benefits, including free health check-up

-Critical illness benefit

-

ManipalCigna FlexiCare Group Insurance Plan

-

-Accidental pre & post-hospitalization

-AYUSH cover

-Air ambulance

-Home care benefits

-Diagnostic benefits

-Counselling expenses

-Home nursing cover

-Travel accidental out-patient benefit

-Wellness benefits, including dental wellness,  health coach, vision care,  alternative treatments, mental care, fitness program & tracking, weight & disease management, stress management, healthy living reward program, healthy reward points

-Obesity & weight control procedures

-Beauty treatments

-Cost of dentures which are not necessitated due to an accident

-Vitamins, minerals and other dietary supplements

See More Plans

Group Mediclaim OPD and Wellness - FAQs

Written By: PolicyBazaar - Updated: 01 September 2020