Insurers Say No to a Standalone OPD Health Plan

16th April, 2014: Insurance companies denied coming up with a standalone OPD Health Plan this soon as there is no point of it when the basic hospitalisation cover in India is so low. 75% of medical spending in India is out-of-pocket according to Swiss RE's report. Low penetration of health insurance in India is one of the reasons behind this. 40% of hospitalised are pushed below poverty line due to lack of financial planning and only 15 % of the population has some form of health cover. Preventive care and out-patient services with high need and frequency of occurrence are not covered by most of the hospitalisation insurance cover. So, these expenses are also paid from pocket even after having insurance.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*(In 120+ cities)
  • Relationship manager For every customer
  • 24*7 claims assistance In 30 mins. guaranteed*
  • Instant policy issuance No medical tests*

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Back
Find affordable plans with up to 25% Discount**
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      What is your existing illness?

      Select all that apply

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      valid-mobile-number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      Even check-ups and minor treatments can be a financial worry for many with rising medical inflation and 70% dependence on private hospitals that have variable and unregulated pricing methods. Apollo Munich and ICICI Lombard have come up with out-patient or OPD insurance in the group insurance segment but there is no retail product in the OPD segment yet which would offer specifically cover expenses related to diagnostic test and treatment costs. The options which are available comes packaged with a health indemnity plan and are either expensive or have many conditions & sub-limits.

      According to insurers, the market is still in struggle with the basic health coverage and secondary coverage like OPD has not been evolved yet. So, this area has not been focussed yet. Apart from this, the current system also doesn't support such a product to be a viable business for them.

      There is no point in taking an OPD cover if a person is not having basic health insurance plan according to K.K. Mishra, the Chief Executive Officer of TATA AIG General Insurance. 

      MD and CEO of Medimanage Insurance Broking, Sudhir Sarnobat said that as OPD charges are not catastrophic in nature, this is not an essential cover in India where basic hospitalization cover is so low.

      According to the Director of Max Bupa Health Insurance, Sevantika Bhandari, it is difficult for insurers to administer the high possibility of overuse or misuse. Once the primary healthcare system in India becomes more organized then the insurance companies will be more comfortable in covering such treatments. After its implementation, companies can even bargain with the clinic chains for offering discounts to customers. However, the treatment can be restricted to clinics only or medicines must be purchased from network clinics only. The visit to doctor can be restricted to four in a year. 

      The primary reason of OPD being a costly insurance product is the lack of substantial data pool on OPD treatments. The protocols and treatments under OPD are not even standardized yet which makes it difficult for underwriters to price & underwrite these products. Necessary steps are taken to make this sector more transparent and organized like Electronic Health Records.

      Search
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Surgeries Covered by Manipal Cigna Health Insurance Plans

      01 Mar 2024

      Amidst the ongoing surge in healthcare expenses, securing
      Read more
      Star Preventive Health Check-ups: All You Need to Know

      29 Feb 2024

      Preventive health check-ups are essential to monitor critical
      Read more
      Reasons to Purchase High-Value Health Insurance Cover

      21 Feb 2024

      When you decide to purchase a health insurance plan for you and
      Read more
      Surgeries Covered by New India Assurance Health Insurance Plans

      22 Feb 2024

      In an era where healthcare expenses are skyrocketing in India, the
      Read more
      Is a 10 Lakh Health Insurance Adequate in Your City?

      10 Jan 2024

      An ongoing medical inflation of 14 percent in India (the highest
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      Best Health Insurance Plans for Senior Citizens
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      Does Health Insurance Provide Coverage for LASIK Eye Surgery?
      A vast majority of the Indian population is suffering from vision problems. For some of them, LASIK eye surgery is
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more
      How Senior Citizens can save Tax with Medical Bills u/s 80 D?
      Senior citizens can save on income tax by availing tax benefits on medical expenses under Section 80D of the Income
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL