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Buy an OPD cover if you visit the doctor frequently

Households with young children, older parents may opt for health policies with in-built OPD feature

Yashish Dahiya 

Buy an OPD cover if you visit the doctor frequently

When was developed initially, it was meant only to cover a person’s hospitalisation and surgical expenses. It has since then evolved steadily in its effort to take care of all the health problems that customers may face. of haemorrhoids, tonsil removal, cystoscopic removal of stones, and so on were not covered by traditional plans until a few years earlier, but are taken care of under day care benefit by most plans today. In some areas, such as (out-patient department) cover, however, limitations remain.
 
Owing to growing risks from environmental hazards and lifestyle diseases, people are visiting hospitals frequently nowadays for smaller medical interventions, such as consultations for minor health issues, diagnostic tests, pre-emptive check-ups, etc. At least the one-fifth of Indians who have chosen to buy don’t like to take a chance with their health, according to reports. However, these visits burn a hole in the pocket, especially of those who live in the big metros.


 
While day care treatments have now been integrated into most new offerings, cover continues to be omitted by most flagship products. This is seen as a major irritant by the population that buys Buyers believe that a policy should take care of every small cost they might incur on health. If they still have to pay for health issues, they become disgruntled.
 
The rising burden of spending is making such a cover even more critical. In India, a whopping 60 per cent of health care spend is on treatment. The lack of an efficient mechanism and absence of a closed network structure are the chief obstacles preventing insurers from introducing worthwhile and sustainable products.
 
A few insurers have now developed an in-built feature in their policies. These include Star Comprehensive plan, Cigna TTK Prohealth, Royal Sundaram Lifeline Elite, Universal Sompo’s Individual Privilege Plan and Apollo Munich’s Health Plan for PolicyBazaar.
 
Do plans offer good value?
 
This is a difficult question to answer because features are not priced separately but are bundled with plain-vanilla plans. This is primarily because a separately priced feature doesn’t follow the principle of and spread of risk, resulting in an almost 100 per cent pricing for the benefits provided. For the benefit of customers here’s a snapshot of the plans that carry as an in-built feature (See table: What is covered under OPD).
 
The level of coverage differs from one plan to another. Some plans only cover expenses incurred on dental consultation or optical treatment in network hospitals, whereas others cover all forms of In the second table (What is covered under OPD), we have provided a brief listing of the coverage that different plans available in the market offer. The policies are for a 35-year-old male living in a metro city with no history of pre-existing diseases.
 
Should you buy an cover?
 
A typical plan that would provide a benefit of, say, Rs 5,000 a year is usually Rs 4,000-4,500 costlier than a normal IPD (in-patient department) plan. Therefore, the decision to buy an cover depends on how frequently you may have to use these services. Typically, families with young kids or older parents who have regular minor health issues may find these plans useful.
 
Universalising the cover  
 
A fairly priced universal plan that provides value to all kinds of customers can develop only when companies develop a strongly administered network of health care providers (clinics, diagnostic centres, medical shops, etc.). The biggest deterrent today for companies who wish to offer such a plan is the pilferage, abuse and misuse of such benefits by a small section of customers and service providers. One way to make such a plan possible would be through the use of a cashless-only network, but that would require investment of significant time and effort by insurers.

Chart

 
companies are already making efforts in this direction. Many insurers have started work on putting together such networks where genuine claims can be handled in a fully cashless manner, providing convenience and efficiency to both customers and companies. Such plans may well become available in the market over the next two-three years. Indian customers will then reap the full benefit of owning plans in their portfolio that are able to take care of all types of health problems they may face.

 The writer is co-founder and CEO, Policybazaar.com

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Buy an OPD cover if you visit the doctor frequently

Households with young children, older parents may opt for health policies with in-built OPD feature

Households with young children, older parents may opt for health policies with in-built OPD feature When was developed initially, it was meant only to cover a person’s hospitalisation and surgical expenses. It has since then evolved steadily in its effort to take care of all the health problems that customers may face. of haemorrhoids, tonsil removal, cystoscopic removal of stones, and so on were not covered by traditional plans until a few years earlier, but are taken care of under day care benefit by most plans today. In some areas, such as (out-patient department) cover, however, limitations remain.
 
Owing to growing risks from environmental hazards and lifestyle diseases, people are visiting hospitals frequently nowadays for smaller medical interventions, such as consultations for minor health issues, diagnostic tests, pre-emptive check-ups, etc. At least the one-fifth of Indians who have chosen to buy don’t like to take a chance with their health, according to reports. However, these visits burn a hole in the pocket, especially of those who live in the big metros.
 
While day care treatments have now been integrated into most new offerings, cover continues to be omitted by most flagship products. This is seen as a major irritant by the population that buys Buyers believe that a policy should take care of every small cost they might incur on health. If they still have to pay for health issues, they become disgruntled.
 
The rising burden of spending is making such a cover even more critical. In India, a whopping 60 per cent of health care spend is on treatment. The lack of an efficient mechanism and absence of a closed network structure are the chief obstacles preventing insurers from introducing worthwhile and sustainable products.
 
A few insurers have now developed an in-built feature in their policies. These include Star Comprehensive plan, Cigna TTK Prohealth, Royal Sundaram Lifeline Elite, Universal Sompo’s Individual Privilege Plan and Apollo Munich’s Health Plan for PolicyBazaar.
 
Do plans offer good value?
 
This is a difficult question to answer because features are not priced separately but are bundled with plain-vanilla plans. This is primarily because a separately priced feature doesn’t follow the principle of and spread of risk, resulting in an almost 100 per cent pricing for the benefits provided. For the benefit of customers here’s a snapshot of the plans that carry as an in-built feature (See table: What is covered under OPD).
 
The level of coverage differs from one plan to another. Some plans only cover expenses incurred on dental consultation or optical treatment in network hospitals, whereas others cover all forms of In the second table (What is covered under OPD), we have provided a brief listing of the coverage that different plans available in the market offer. The policies are for a 35-year-old male living in a metro city with no history of pre-existing diseases.
 
Should you buy an cover?
 
A typical plan that would provide a benefit of, say, Rs 5,000 a year is usually Rs 4,000-4,500 costlier than a normal IPD (in-patient department) plan. Therefore, the decision to buy an cover depends on how frequently you may have to use these services. Typically, families with young kids or older parents who have regular minor health issues may find these plans useful.
 
Universalising the cover  
 
A fairly priced universal plan that provides value to all kinds of customers can develop only when companies develop a strongly administered network of health care providers (clinics, diagnostic centres, medical shops, etc.). The biggest deterrent today for companies who wish to offer such a plan is the pilferage, abuse and misuse of such benefits by a small section of customers and service providers. One way to make such a plan possible would be through the use of a cashless-only network, but that would require investment of significant time and effort by insurers.

Chart

 
companies are already making efforts in this direction. Many insurers have started work on putting together such networks where genuine claims can be handled in a fully cashless manner, providing convenience and efficiency to both customers and companies. Such plans may well become available in the market over the next two-three years. Indian customers will then reap the full benefit of owning plans in their portfolio that are able to take care of all types of health problems they may face.

 The writer is co-founder and CEO, Policybazaar.com
image
Business Standard
177 22

Buy an OPD cover if you visit the doctor frequently

Households with young children, older parents may opt for health policies with in-built OPD feature

When was developed initially, it was meant only to cover a person’s hospitalisation and surgical expenses. It has since then evolved steadily in its effort to take care of all the health problems that customers may face. of haemorrhoids, tonsil removal, cystoscopic removal of stones, and so on were not covered by traditional plans until a few years earlier, but are taken care of under day care benefit by most plans today. In some areas, such as (out-patient department) cover, however, limitations remain.
 
Owing to growing risks from environmental hazards and lifestyle diseases, people are visiting hospitals frequently nowadays for smaller medical interventions, such as consultations for minor health issues, diagnostic tests, pre-emptive check-ups, etc. At least the one-fifth of Indians who have chosen to buy don’t like to take a chance with their health, according to reports. However, these visits burn a hole in the pocket, especially of those who live in the big metros.
 
While day care treatments have now been integrated into most new offerings, cover continues to be omitted by most flagship products. This is seen as a major irritant by the population that buys Buyers believe that a policy should take care of every small cost they might incur on health. If they still have to pay for health issues, they become disgruntled.
 
The rising burden of spending is making such a cover even more critical. In India, a whopping 60 per cent of health care spend is on treatment. The lack of an efficient mechanism and absence of a closed network structure are the chief obstacles preventing insurers from introducing worthwhile and sustainable products.
 
A few insurers have now developed an in-built feature in their policies. These include Star Comprehensive plan, Cigna TTK Prohealth, Royal Sundaram Lifeline Elite, Universal Sompo’s Individual Privilege Plan and Apollo Munich’s Health Plan for PolicyBazaar.
 
Do plans offer good value?
 
This is a difficult question to answer because features are not priced separately but are bundled with plain-vanilla plans. This is primarily because a separately priced feature doesn’t follow the principle of and spread of risk, resulting in an almost 100 per cent pricing for the benefits provided. For the benefit of customers here’s a snapshot of the plans that carry as an in-built feature (See table: What is covered under OPD).
 
The level of coverage differs from one plan to another. Some plans only cover expenses incurred on dental consultation or optical treatment in network hospitals, whereas others cover all forms of In the second table (What is covered under OPD), we have provided a brief listing of the coverage that different plans available in the market offer. The policies are for a 35-year-old male living in a metro city with no history of pre-existing diseases.
 
Should you buy an cover?
 
A typical plan that would provide a benefit of, say, Rs 5,000 a year is usually Rs 4,000-4,500 costlier than a normal IPD (in-patient department) plan. Therefore, the decision to buy an cover depends on how frequently you may have to use these services. Typically, families with young kids or older parents who have regular minor health issues may find these plans useful.
 
Universalising the cover  
 
A fairly priced universal plan that provides value to all kinds of customers can develop only when companies develop a strongly administered network of health care providers (clinics, diagnostic centres, medical shops, etc.). The biggest deterrent today for companies who wish to offer such a plan is the pilferage, abuse and misuse of such benefits by a small section of customers and service providers. One way to make such a plan possible would be through the use of a cashless-only network, but that would require investment of significant time and effort by insurers.

Chart

 
companies are already making efforts in this direction. Many insurers have started work on putting together such networks where genuine claims can be handled in a fully cashless manner, providing convenience and efficiency to both customers and companies. Such plans may well become available in the market over the next two-three years. Indian customers will then reap the full benefit of owning plans in their portfolio that are able to take care of all types of health problems they may face.

 The writer is co-founder and CEO, Policybazaar.com

image
Business Standard
177 22