Need for OPD Benefits in Health Insurance Plans!

When it comes to health, every one of us needs to be pro-active. This requires anticipation of future medical contingency and prepare to deal with it in advance. This involves the creation of a plan inclusive of OPD benefits. Many insurers don’t own such benefits as of now, but adding them can let policyholders purchase a better health insurance plan with which they can face medical expenses of all sorts.

Why is it necessary?

Although there are many points to support the requirement of this OPD benefit in plans, having a random word with any senior citizen can give you an idea of its need. You can get surprised to know the gravity of the financial burden they have to face due to their health care expenses, which reaches to around Rs 2 Lakh per year including hospitalisation and day-to-day medical expenditures. However, the following are some causes that lead to the addition of OPD feature-driven plans as a need of the hour. 

Growing Need: With the advancement in medical science, the chances of living a longer life will be higher. But, due to the sedentary lifestyle that people follow nowadays, our generation might fall prey to chronic diseases in the future, which in turn can result in day-to-day medical expenses after a certain age. The encounter of this health situation with health care inflation can give birth to a fearful condition. Daily healthcare costs of medicines, diagnostic examinations and doctor’s fee sum up to around a major percentage of the nation’s total health care industry. But many private and government medical schemes only offer hospitalisation coverage and eliminate the out-patient department (OPD) expenses. Hence, the need for OPD benefit equipped health insurance plans, which can cover daily medical expenses is on the rise.

Fragmented healthcare market: When it comes to the outpatient health care market in the country, it is found as fragmented and disorganised. This problem lies due to the fact that a health insurance plan with OPD cover needs the amalgamation of several ecosystems. Under such coverage, the plan must offer health care related benefits such as doctors’ fee, diagnostic labs, pharmacy bills etc., with a cashless payment platform. In addition to this, several renowned doctors and health care facilities don’t get listed under the list of network hospitals of the plans. In such situations, proper OPD treatments are needed to be paid from the pockets for which plans with out-patient treatment expenses are in demand. 

Slow adoption of technology: Not able to adopt advanced technology has been a big flaw in our country. This majorly involves slow or no adaptability to modern medical technologies by doctors and specialists. However, many hospitals, diagnostic centres and pharmacies are now found to be equipped with technology to generate bills and to draft reports. While various health-tech organisations are indulged at integrating specialists or doctors, diagnostic labs, pharmacies etc., through technology. But, until and unless this adoption isn’t picked up by the doctor’s community, health insurance plans won’t be able to deliver the best possible treatment to policyholders. Hence, OPD covered plans with the affiliation of advanced hospitals is the only way out. 

Lack of health care records: Unlike developed nations such as the UK, the USA and others, India doesn’t possess organised health records at the national level. The un-updated health data enhance the trouble of insurers to underwrite the risks. This is a matter of the maximum number of OPD covers which are ineffective on the amount of premium. The product’s additional price is almost the same as that of annual OPD coverage, where many covers are restrictive and available with 3-4 years of waiting periods or provide low limits for every consultation. A good plan can empower you to step ahead and find your way towards getting the proper OPD treatment without entangling in such operational flaws. 

Risk of fraud: Insurance providers are functional on a specific format of health insurance, where the mere covering of hospitalisation is considered enough. It is going on for around two decades now. In spite of investing on a large scale in technology and trying to put operational controls in place, a considerable part of the claims paid-out every year turn out to be fraudulent. The OPD costs are considered to be an entirely different ball game. However, without an organised pack of technology and system, a constant fear of fraud will reside. Therefore, earnest and consistent efforts of insurers are being enforced to introduce such benefits or plans in the nation. Hence, to safeguard yourself from a situation of being deprived of OPD treatments, opting for a complete health insurance policy is the perfect solution. 

Also Read

Covering OPD Cover in Health Insurance

Health Insurance with OPD Cover or Health Card?

Conclusion

The health insurance isn’t just about hospitalisation, it’s much more than that. The present insurance offerings that include outpatient expenses are a part of initial experiments to provide the customers with organised outpatient network infrastructure. It is a need of today and its reasons are listed above. 

You may also like to read: Choose Best Health Insurance with OPD Cover Today

The OPD benefit stuffed insurance plans are in demand as it would protect your medical rights from getting compromised during treatment without hospitalisation. Therefore, it is recommended that the insurance sector should work closely to develop healthcare insurance products with relevant benefits, strong systems, proper procedures, and a cashless network to spread such benefits efficiently. 

In short, a few years of integration and experiments are required for getting relevant and cost-effective solutions related to OPD expenses. Introduction of relevant OPD products with relevant improvements will meet the needs of customers and boost demand from potential customers, who find no value in purchasing hospitalisation insurance.