Money & Banking

Insurers looking at cover for outpatient treatment

Shobha Roy Kolkata | Updated on March 12, 2018 Published on April 06, 2012

Balm for OPD spends: The waiting area of the Outpatient Department at a hospital in Vijayawada, Andhra Pradesh.

Say lack of standards makes fraud detection a challenge. Insurers are looking at providing covers for outpatient treatments.

Insurers are looking at providing covers for outpatient treatments.

With the cost of outpatient treatments (OPD) – including consultation and diagnostics – on the rise, general insurance companies are increasingly looking at providing cover for such treatments.

While some companies are offering OPD schemes as add-on covers with the inpatient policy (hospitalisation cover), some others are providing discounts at network hospitals.

“Insurance company try to offer this as a service to their customers. This is because unlike life insurance, health insurance policies do not pay you back. So a customer who does not claim anything during a particular year often considers the policy as a waste,” said Mr Neeraj Moorjani, head-product and brand management, Chola MS.

Chola offers either reimbursements or goes for co-payments for OPD treatments under its Individual Healthline and Tax Gain policies. There is, however, a cap on the amount of claims that can be made.

According to Mr Sanjay Datta, Head – Underwriting & Claims, ICICI Lombard GIC Ltd, the demand for OPD cover is on the rise. “We provide it as a small sub-limit within our existing health insurance policy. Under this a customer can claim about Rs 10,000 for outpatient treatment in a year,” he said.

Discount on health card

Bajaj Allianz General Insurance allows its health card holders to avail discounts on OPD treatments at its network hospitals.

“Our health insurance customers can avail this value added service at network centres. A customer can avail discounts in the range of 20-30 per cent on various IPD and OPD facilities such as medical tests and consultations,” said Mr Suresh Sugathan, head, health administration team.


The biggest challenge in providing cover for OPD treatments lies in the operational part of it, said Mr Neeraj Basur, chief financial officer, Max Bupa.

“Potential of misuse or overuse is high and insurance companies find it difficult to administer. Unlike hospitalisation, OPD has multiple transactions and managing them could be an issue for insurers,” Mr Basur said.

Max Bupa provides a sub limit for OPD under its Heart Beat Platinum policy, for diagnostics and consultation at its network hospitals.

Insurance cover for OPD is prevalent in western countries where the systems are standardised, said Dr Amarnath Ananthanarayanan, chief executive officer and managing director, Bharti AXA.

“The challenge is not evolving a product but to put a check on frauds. There is a lack of standardisation in this segment in India. Possibilities of fraud either by the customer, doctor or clinic discourage insurers,” he said.

Bharti AXA offers OPD cover under its group insurance policies at present. “We will look at offering in our individual health policies once the segment gets more organised,” he pointed out.


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Published on April 06, 2012
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