Health insurance: Here’s why OPD claims are growing more than in-patient ones

COVID-19 has led to an increase in the awareness among corporate India towards health insurance. But it is no longer about in-patient expenses, as now the focus has also been shifted to outpatient expenses such as regular medical check-ups, pharmacy benefits, etc to encourage employees to have good health. According to Medi Assist Insurance TPA, for the first time, the number of outpatient claims processed will be higher than the number of in-patient claims. It has happened because of the amount of OPD penetration that’s actually happening in the group insurance product.

“Out of 6 million claims we processed, little over 3 million will be outpatient, just under 3 million will be in-patient. This is because most companies have encouraged their employees to get regular health checks done, or pharmacy benefits. Often these are very high frequency, low ticket value from a value perspective. But from a volume perspective, we've actually crossed in-patient. That's something I never thought I would see,” said Satish Gidugu CEO Medi Assist Insurance TPA. Medi Assist has become India’s first Third Party Administrator (TPA) to service more than Rs 10,000 crores of the active group and retail healthcare premiums.

Due to the ongoing pandemic, awareness has grown for employee wellness programs. Companies have now started focusing on wellness programs compared to the pre-Covid era. Employers have realised that health insurance does not end with having a cover just for hospitalization expenses. What is equally important is to have a solution that encourages employees to have good health.

Abhishek Poddar, co-founder and CEO of the employee health insurance platform Plum earlier told BT, "There has been a recognisable increase in awareness and demand for employee wellness programs by companies compared to pre-Covid times. Plum has seen a surge in its teleconsultation services for both general healthcare and mental wellbeing. We are seeing a rise in demand wherein almost all of our 1000+ customers are looking for a health benefits program post-Covid.”

For Saransh Garg, co-founder and CEO of Nova Benefits, an employee wellness platform focussed on corporate health insurance, employees are now going for schemes that target overall benefits.

“They are looking at doctor consultation, health check-ups, creating fitness challenges, health risk assessment, etc. So, companies are going deeper into how they can improve the health and wellness of their employees,” Garg said.  

Recently on the retail side also many insurers have launched OPD solutions to cover outpatient expenses such as doctor's fees, diagnostic costs, pharmacy, among other things.