Insurance cover for OPD, dental too

Those spending a fortune on the treatment of some chronic diseases but not getting insurance benefits because their treatment does not require hospitalisation will now have something to cheer.

Health insurance plans, which until now covered expenses only if the insured is hospitalised, will soon include outdoor patient department (OPD) benefits and dental care in their ambit. The inclusion of OPD benefits imply that the insured need not be hospitalised to seek insurance benefits.

Typically, health insurance plans cover treatment expenses when the insured is hospitalised for more than 24 hours.

But, some of the insurance companies like Bajaj Allianz General Insurance and Max Bupa are planning to provide such services in the wake of the government’s directive to make insurance sector more attractive to consumers. Sources from these companies said an inclusive health care plan with OPD cover will likely be in the market by the year-end.

With a few exceptions, Indian insurance companies have products without OPD cover. A handful of those providing OPD cover charge additional premium.

“The objective of this policy is to provide the policy holders with maximum insurance benefit under the policy.

The new plan will covers all OPD expenses like consultation with the doctor, pathological tests and medicines,” said Anand Nandan, head of the health segment in Bajaj Allianz.

In recent times, there is an increase in the number of dialysis patients and those down with arthroscopy, who do not need hospitalisation for more than 24 hours, but incur huge medical expenses and the insurance cover can benefit them.

Women with complicated deliveries also need a series of pre-natal tests and medication, which have resulted in higher childbirth expenses. Health insurance with OPD cover is thus beneficial for women during pregnancy and childbirth.

Some non-life insurance companies are in the process of launching retail health insurance policies that cover alternative forms of treatments, while several insurers, which already cover such treatments, are in the process of increasing the limits.

The country’s largest general insurer, New India Assurance, which covers alternative treatments up to 25 per cent of the sum insured, has already filed a product with the regulator, the Insurance Regulatory and Development Authority (IRDA), with higher limits.

ICICI Lombard General Insurance, the largest private insurer, too has filed for approval of a product with Irda that will provide OPD coverage under alternative treatments, but without hospitalisation benefit.

Alternative treatments referred to as Ayush (Ayurveda, Unani, Siddha, and homeopathy) is so far offered by a mere seven non-life insurers out of 24 companies with limits and conditions. The insurers that cover hospitalisation under alternative treatments are New India Assurance, United India, Oriental Insurance, National Insurance, Tata AIG, HDFC Ergo General and Cholamandalam General Insurance.

New scheme
* Inclusion of OPD benefits means insured need not be hospitalised to seek benefits
* Most Indian insurance companies have health plans without OPD cover
* Those who do provide the service charge additional premium
* Inclusive healthcare plan with OPD cover will likely hit the market by year-end