Covid-19 cases are on the rise again. India saw 10,542 new cases of coronavirus in the last 24 hours, taking the total active cases in India to 63,562, according to the Union Health Ministry data updated on Wednesday. In such a scenario it is important to understand if your health insurance policy covers the cost incurred on treatment of Covid-19.
First you should know that a regular health insurance policy covers only hospitalisation expenses and not outpatient costs like doctor consultation, lab tests and pharmacy bills. It covers the Covid-19 related treatment costs only after the hospitalisation of at least 24 hours.
“To cater to the changing needs, insurers are persistently bringing in new features and making the health insurance policies more comprehensive. Even the most standard health insurance policies cover the expenses pertaining to hospitalization due to Covid-19 and its associated variants,” explained Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com.
So, to cover this gap in your health insurance policy, many insurers have now started offering comprehensive OPD health plans. The need for having OPD plans have gone up, particularly after the pandemic when many people were getting treated at their homes as hospitals were running full.
“An insurer who has a health insurance policy with OPD as a rider, which approximately costs (15 per cent -20 per cent extra premium) can claim expenses such as doctor's consultation fees, diagnostic tests, pharmacy bills, etc.," said Singhal.
So, if you are thinking to buy an OPD plan let’s first understand the type of plans available in the market.
Types of OPD Health Insurance Plans
OPD plans can broadly be classified into three types. First, the very basic OPD plan gives you only online doctor consultations. Then there are plans that offer consultations both online and offline. And the third which is also the most optimum plan gives you online and physical consultations and covers your lab tests and pharmacy expenses. So, the next relevant question is where to buy it from.
Where to buy OPD Plan?
You can either buy OPD coverage as a built-in feature with a base plan or as a rider with the basic policy. A few of the options include ICICI Lombard’s BeFit, Bajaj Allianz General Insurance’s ‘Health Prime’ rider and ManipalCigna Health Insurance’s ProHealth Prime Advantage. Now most importantly how much does it cost?
How much does it cost?
OPD plans generally offer coverage in the range of Rs 5,000 to Rs 60,000. For evaluating how much it costs to buy such a plan let’s consider the example of ICICI Lombard’s BeFit policy. The premium for a 23-year-old who wants to opt only for virtual consultations is Rs 297 with the sum insured of Rs 6,000. Similarly, for a 60-year-old person who wants the most comprehensive OPD coverage, the premium will work out to Rs 6,558 for a sum insured of Rs 55,000. For other OPD plans check the table shared above assuming a basic health cover of Rs 5 lakh for a 35-year-old man.
Fine prints
Now we know the coverage of OPD plans, it is vital to note the exclusions, too. For instance, some cases that are not included in the plans are cosmetic treatments, adventure sports, non-prescribed dietary supplements, treatment for addictions, spas, among other things.
Most importantly, do not go for reimbursements which can turn into a cumbersome claims process. These days many plans offer a cashless facility where one can book an appointment with a doctor online, post which the claim is settled through the app of the insurer.
Another key factor to examine before buying an OPD plan is that there should be enough empanelled doctors for a quick consultation. Next, you should also look at the coverage allotted for overall and per consultation, as it should be enough to cover the cost. Moreover, it is always good to have a policy that provides the facility of OPD throughout the day as the emergency comes unannounced.
The health insurance policy covers your hospitalisation expenses. For covering the cost of doctor consultation, diagnostic and pharmacy you need to buy an OPD plan. But before buying an OPD plan, you should check the coverage, its exclusions as well as the network of doctors available in your area.