Insurance companies lining up cashless OPD plans to make life easier

MUMBAI: The next time you want to see the doctor, you may not have to pay, even if you are just an outpatient. But that’s only if you are covered by a health insurer which includes the hospital that you are visiting in its network. As with anything related to the business, there are many caveats, but this could still end up being the next big thing in health insurance — cashless OPD.

Some companies are experimenting with the concept of customers not having to pay when they visit an outpatient department, or OPD. Insurance companies only started covering outpatient treatment a few years ago, but strictly through reimbursements. That meant the customer paid and then put in a claim for the money. It wasn’t covered before that, with medical insurance policies only kicking in when there was a minimum 24 hours of hospitalisation.

Apollo Munich’s Maxima is now offering vouchers for various services such as consultation and pharmacy.

“We are offering vouchers for OPD treatment with sub limits,” said Antony Jacob, MD and CEO of Apollo Munich Health Insurance. “This is available in designated outlets. We reimburse if the hospital is not in our network list.” There are limits — for consultations, the insurance company gives a voucher of Rs 600. There are also caps on the number of times a customer can seek a consultation to check against misuse.

The average premium for such plans is Rs 13,000-15,000, providing for coverage of Rs 3-5 lakh. ICICI Lombard is planning a similar product. “We are planning to bring OPD on cashless platform,” said Sanjay Datta, head of health at ICICI Lombard. “We will soon start a pilot.” This should help ease life for the average insurance customer.

“Cashless OPD is more about convenience, so that you do not have to follow up with the company for reimbursement,” said Rahul Agarwal, managing director, Optima Insurance Broker.

The move could encourage more people to opt for health insurance. At a time the economic slump has hit the nonlife insurance business, health is the fastest-growing segment, having benefitted from increased awareness due to the rise in medical costs. Health is also profitable for insurers with an incurred claim ratio of 96.43%. This is the ratio of claims paid to premium earned. The government has also sought to promote health insurance by providing a tax break to those who buy policies.

Health insurance premiums grew 18.66% to Rs 13,975 crore in 2012-13 from Rs 11,777 crore a year before. Over the past seven years, the segment has grown at a compounded annual growth rate of 30%, compared with 17.5% for the non-life industry.

The Insurance Regulatory & Development Authority issued guidelines last year to bring uniformity in health insurance policies. These have led to the standardisation of commonly used medical terms, procedures, exclusions and claim forms.