Health insurance: Take OPD cover in your planHealth insurance: Take OPD cover in your plan

With HEALTHCARE increasingly more expensive and the share of out-of-pocket expenses growing, it is important to optimise your health insurance and ensure the best coverage. Insurance companies are now offering a host of options to customise and address the unique medical needs of customers.

You should review your existing coverage and try to upgrade to a policy that offers cashless outpatient department treatment (OPD), daily cash rider, guaranteed cumulative bonus and lower sub-limits. Moreover, add certain essential riders and take a top-up to make the insurance cover comprehensive. If your existing plan does not offer these cost-effective features, consider porting to a plan that offers these features from the same or a different health insurer.

While a basic health insurance covers only hospitalisation, a substantial part of healthcare costs is related to doctor consultations, medicines and diagnostics. A policy with cashless OPD will take care of such expenses and is beneficial to those with higher out-of-pocket expenses or parents with young children prone to ailments that require over-the-counter medicines or medical tests.

Cashless OPD will include professional fees, diagnostic fees, medicine bills, treatments for fractures, dental treatments, minor surgeries from authorised diagnostic centres, dental care centres and pharmacies. However, most insurers exclude OPD expenses incurred towards spectacles, contact lenses, ambulatory devices such as walkers, etc.

Vikul Goyal, founder & CEO, Bimaplan, an insurtech, says health insurance with cashless OPD benefit helps in reduction of out-of-pocket expenses. “Senior citizens must opt for OPD cover as it along with consultation fees, also covers diagnostic charges and pharmacy bills. This makes the cashless OPD benefit flexible and comfortable, especially for those suffering from chronic diseases who need regular OPD visits,” he says.

Guaranteed cumulative bonus

Look at a policy with guaranteed cumulative bonus that protects loss of cumulative bonus post claim, in exchange for the same premium. There are a few health plans that offer guaranteed cumulative bonus of 25-30% per year, going up to 200% of sum insured, irrespective of claim.

However, if you opt for fresh coverage for this amount, you will have to pay an extra premium.

Also, look for a policy that offers a loyalty discount on the applicable premium after a few years of renewal. Some insurers offer additional discounts if the policy is renewed through National Automated Clearing House or standing instruction either by direct debit of bank account or credit card. Nayan Goswami, head, General Insurance, Sana Insurance Brokers, says opting for guaranteed cumulative bonus is beneficial as it results in a higher coverage amount without any extra premium.

Restore benefits, riders

Go for a policy that offers restoration benefits if the sum insured is exhausted in the policy year due to hospitalisation. It is an ideal feature in a family floater plan. If the base cover of the floater is exhausted, the family members continue to get coverage on restoration of sum insured.

Avoid a health insurance plan with high co-pay or deductible. While it may reduce your premium, your out-of-pocket expenses will be higher. Better opt for a higher deductible super top-up plan and higher base plan. Most health plans offer essential riders, for an extra premium such as critical illnesses, that you can choose based on your needs.


* Cashless OPD includes professional fees, medicine bills, diagnostic fees, treatments for fractures, dental treatments, minor surgeries, etc

* Guaranteed cumulative bonus protects loss of cumulative bonus post claim, in exchange for the same premium

* Add essential riders & a top-up plan to make the insurance comprehensive

Date: 16/11/2022/ Source: Financial Express