Get your outpatient medical expenses covered.

Close to the heels of private sector insurance companies coming out with packages to cover your Outpatient Department (OPD) costs, government sector companies have also introduced similar plans to stay competitive in the market. Over the last two to three years, new private sector general insurance companies and standalone health insurance companies have been offering policies covering OPD.

Health Insurance in India typically covers medical expenses arising as a result of 24 hours of hospitalisation only. Very often these less than 24 hours visits to the doctor also cost a huge amount of money with the doctors prescribing various tests and scans. The flip side of insurance companies not covering OPD medical expenses was that individuals often ensured that there was 24hours hospitalisation even in cases it was not required medically. This in turn led to escalation of costs for the insurance companies.

OPD, meanwhile, covers doctor consultation, diagnostic tests and medicines. This step will ensure that false hospitalisation is considerably reduced. According to leading insurance companies, OPD cost consists of almost 60 per cent of overall medical spends in India. So the insurance companies felt need to get into that space and offer reasonably priced products.  For insurers, covering OPD is not an easy scheme as the size of claims is small and frequent. There are logistic difficulties in managing OPD, apart from the probable loss experience and these insurers have to ensure that it does not become an unviable portfolio.

The move to cover the OPD space will provide a wider portfolio for general insurers. Health insurance is one of the rapidly growing sectors for the industry growing 18.66 per cent to Rs. 13,975 crore in 2012-13. Let us all hope that OPD cover becomes a viable portfolio for the insurers so that we as individuals can reap the benefit.