This is a very common question which we come across from our customers. In fact those who are familiar with USA or are returning from there find it very strange that most of the Indian insurance companies have products which do not cover OPD.
The exceptions are;
ICICI Lombard’s “Health Advantage Plus” and
Apollo Munich’s “Maxima” Health Insurance plan.
ICICI Lombard’s Health Advantage Plus covers OPD expenses from the first day of the policy. The objective of this policy is that policy holders can enjoy maximum benefit under Section 80D as per applicable tax laws. It also offers/ covers all OPD expenses i.e. consulting, tests or medicines.
In recent times, there has been a rise in the number of Caesarian section births. Increasingly we see more complicated deliveries, a series of pre-natal tests and medication which have resulted in higher childbirth expenses. Health insurance with OPD cover is thus beneficial for women during pregnancy and childbirth. ICICI Lombard provides maternity cover as part of the Health Advantage Plus policy.
The OPD cover may vary from Rs. 2,000 to Rs. 10,000 depending on the plan opted and the age profile of policy holder.
One can claim OPD charges only once during the policy term so one has to keep all the bills paid safely to get the reimbursements as and when the limit is reached.
The Apollo Munich’s Maxima benefits includes , cash- less OPD expenses across trusted network of pharmacies for pharmacy bills, diagnostic centers for diagnostic tests and annual health check-up, dental and optical care centers for contact lenses, spectacles and dental treatments along with consultation with family doctors.
The maximum benefit allowable for 1 adult is Rs. 8,500 [350*3 + 500*1 + 1,000 + 2,000 + 1,000 + 1,000 + 2,000(estimated)]
In addition, both the policies do not allow, an insured person to claim OPD cost within 90 days of commencement of the policy.
If we go for a normal health insurance policy, the premium paid is much less compared to these policies; as a result we end up paying more than the benefits we may receive.
Let us see the choice with examples:
Example 1:
Mr. X aged 30 years buys individual Health Advantage Plus plan from ICICI
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 16,545
Less: Tax saved : Rs. 4,964 (30%)
Net premium : Rs. 11,581
Now if he takes normal healthcare policy from New India
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 3,871
Less: Tax saved : Rs. 1,161(30%)
Net premium : Rs. 2,710
So, to avail OPD coverage of Rs. 8,800 (which he will not be able to claim without unnecessary visits etc.) he pays a premium of Rs. 8,871 extra.
Example 2:
Mr. X aged 30 years buys individual Maxima plan from Apollo:
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 15,216
Less: Tax saved : Rs. 4,565 (30%)
Net premium : Rs. 10,651
Now if he takes normal healthcare policy from New India:
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 3,871
Less: Tax saved : Rs. 1,161 (30%)
Net premium : Rs. 2,710
So, to avail OPD coverage of Rs. 8,500 (which he will not be able to claim without unnecessary visits etc.) he pays a premium of Rs. 7,941 extra.
The conclusion drawn is by having these policies you are getting the benefit in the ratio of 1:1 only.