More group health policies now cover OPD expenses

MUMBAI: Group health insurance policies are beginning to cover outpatient department (OPD) expenses incurred by employees.

According to a survey by Vantage Consulting, 11% of the companies surveyed out of a pool of 129, are offering outpatient treatment under the group health insurance policies. Typically, outpatient department products extend cover to treatments not requiring 24-hour hospitalisation, or are not included under the day-care procedures.

“Most corporates are paying for in-patient hospitalistion, so they have given an option to employees to fund their premium for outpatient treatment,” said Sanjay Datta, head of health insurance at ICICI Lombard.

He, however, said that the scheme — which is available on both cashless and reimbursement basis — has not taken off in a big way. These are customised products worked out between the corporates and insurers. Insurance companies started covering outpatient treatments only a few years ago through reimbursements. That meant the customer settled the bill and then put in a claim for reimbursement.

Earlier, under health insurance policies and group health, medical insurance policies only kicked in when there was a minimum 24-hours of hospitalisation. There are cashless OPD treatments available in the market where insurance companies give a voucher for consultations.

With competition intensifying, insurance companies have begun to cover day-care procedures in hospitals instead of the mandatory overnight stays. About 84% of the companies do such payments now, says the survey.

Health insurance premiums grew 13% in 2013-14 to Rs 17,500 crore against 19% 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.