Mediamanage : OPD covers under health insurance policies?

A decade ago doctors used to charge nominal amount between Rs 50 and Rs 100 for each consultation and that fee rapidly touched the sky which starts from 200 nowadays and keep going on as per the specialists’ demand. The reason behind this hike in consultation fee is the reliability on imported lab equipments and compensation of technicians. And outpatient charges are not even covered in health insurance policies.

There is lack of insurances that cover OPD benefits for its policy holders. For example Apollo Munich considers covering only 1% of outpatient cover of the sum insured and that is too with cap at Rs 5,000. And in Cigna TTK plan, only Rs 2,000 will be paid towards OPD claims if the insurance is somewhere between Rs 4.5-10 lakh. Rs 30,000 can be claimed as OPD charges if insurance costs minimum Rs 15 lakh under family floater plan, ‘Heartbeat Platinum Plan’ of Max Bupa.

As OPD covers are expensive, insurers sell the insurances which include OPD charges, by showing it off as a big advantage to the prospective policy holder. National insurance covers the OPD claim of Rs 10,000 for two adults with eldest aging 35, at the premium of Rs 6,000. On the other hand Religare covers OPD claims of almost Rs 10,660 to the couple with lower premium under the hospitalization policy of Rs 10 lakh.

Director of leading health insurance consultancy firm medimanage.com, Mr. Sudhir Sarnobat said that the best option to cover the OPD expenses is to manage it from one’s own pocket because it makes sense to be better prepared than depend on a policy for the same.

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