The government of India released the report of National Health Accounts Estimates (NHAE) in April 2023. The report states that the out-of-pocket expenditure or OOPE of individuals has decreased from the Total Health Expenditure (THE) percentage. The OOPE was 62.6% during 2014-15. However, in 2019-20, it was estimated to be 47.1%. The decrease in OOPE is good news for a developing nation. It indicates a good sign of the government increasing the healthcare infrastructure and insurance penetration in the insurance sector. Nevertheless, it is important to note that the OOPE is still higher as compared to other developed nations. It still has the scope to move downward. India may achieve this goal with a comprehensive health insurance policy. It covers both hospitalisation and OPD costs. Both coverages have their own importance. Hence, it is crucial to understand the meaning and difference between regular and OPD health insurance policies.
The coverages provided by regular health insurance and OPD health insurance are different.
The regular health insurance plan offers coverage of expenses pertaining to the hospitalisation of a policyholder. The policyholder is required to be hospitalised for a minimum period of 2 hours in order to cover the expenses incurred by the insurance company. Day care procedure is the exception to regular health insurance policy. These treatments do not require more than 24 hours of hospitalisation. Such treatments can be accomplished in less than a day. The expenses under the day care procedure shall be covered by the regular health insurance policy. The insurance policy mentions the list of day care procedures which are expected to be covered under the regular health insurance policy.
However, the other medical expenses shall fall outside the purview of the regular health insurance policy. These expenses can only be covered by the OPD health insurance plan. In the absence of an OPD plan, the policyholder is required to pay the medical bill from his own pocket.
The patient is not required to be hospitalised in order to fall under the purview of OPD coverage. The patient generally obtains consultation from the doctor regarding health issues.Under this, the patients are not expected to be hospitalised. Hence, the coverage is offered under the scope of the OPD insurance plan.
The OPD health insurance plan includes the following coverage.
Now, one may draw the major differences between the regular health insurance plan and the OPD health insurance plan.
An individual or policy buyer must purchase an OPD insurance plan in order to avoid the following expenses.
The regular health insurance plan and OPD health insurance plan come with several benefits.
Here are the key benefits of a regular health insurance plan.
Here are the key benefits of the OPD health insurance plan.
A regular health insurance plan offers hospitalisation expenses. At the same time, the OPD health insurance plan covers specific medical expenses. The policyholder is not required to be hospitalised in an OPD health insurance plan. The treatment can be done by paying a visit to the medical practitioner. The OPD health insurance product covers the expenses incurred by the policyholder to pay the doctor fees. This includes pharmacy bills, diagnostics charges, consultation fees of doctors, etc. It also covers the charges paid by the policyholder for the regular visit to the doctor. Hence, it is an ideal plan to reduce the financial burden and claim an income tax deduction.
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A. Here are some exclusions of the OPD insurance cover.
A. The below-mentioned expenses can be covered under the OPD health insurance.
A. The policyholder is required to provide the hospital bills and other documents sought by the insurance company in order to settle the claim.
A. It is at the discretion of the insurance company whether it provides the insurance policy which only covers OPD treatment. Therefore, the policyholder must review the plan carefully in order to find out the insurance companies which cover the OPD treatment.
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