As much as one would want to avoid the topic, Covid cases seem to be on the rise again. The fresh Covid cases reported at 1,573 on March 28 may be small compared to peaks; 4 lakh per day in early May 2021 and 3 lakh per day in January 2022 (Omicron wave). But after flatlining to 100-200 cases per day year-to-date, the daily case count has inched up to four figures again, worrying authorities. The current season also has an increased viral activity (flu, influenza) apart from Covid. Covid-related health insurance aspects may need to be revisited and we reiterate why OPD covers should gain importance as part of health insurance packages.
Health insurance for Covid
Covid Raksha and Covid Kavach were two policies (benefit plan and indemnity plan) launched in the early days of the pandemic, mandated by regulator IRDAI as part of its Covid response. But after being extended till September 2022, in March of that year, by IRDAI, there may not be much traction for the two currently. Even otherwise, a comprehensive health insurance should be the main stay of protection, beyond the patchwork insurance offered by the two.
Covid, being a viral infection, can be covered by any insurance policy, if the policyholder is hospitalised on doctor’s recommendation. The sum insured without sub-limits can be expected to cover the hospitalisation expenses. But while insurance cover for hospitalisation is not a hurdle in many other diseases, in a few Covid cases hospitalisation may not be required as per doctor’s recommendation. Even for patients suffering from long-Covid (an umbrella term for as yet undiagnosed impact of Covid, including breathlessness, brain fog and fatigue for long periods) insurance cover may fall short, without hospitalisation.
Again, the cover for hospitalisation does not include consumables, which is typically higher for Covid-related cases where sterile equipment has to provided for the Covid wing of the hospitals. This particular practice gained ground post-pandemic and may top 20 per cent of the bill (which is not covered by insurers). Some policies cover consumables as part of the basic cover (HDFC Ergo Optima Secure, TATA AIG Medicare) and others have a purchasable add-on to cover consumables.
Viral concerns
More recently, there has been an increased incidence of influenza, including H3N2 virus causing severe seasonal flus. Similar to pent-up demand in theatres, restaurants or holiday destinations, there appears to be a pent-up onslaught of viral infections as schools and public spaces opened up in the last two years.
OPD (Out patient department) consultation, where only a doctor visit and diagnostics are involved, is key to handling the current viral onslaught. Having an OPD cover is hence becoming increasingly important for health policies.
A typical OPD cover reimburses OPD consultation and the prescribed diagnostic tests/ medicines with sub-limits ranging from ₹1,500 to ₹20,000 per year as part of the overall health insurance cover. Insurers may cover OPD expenses starting from day-1 unlike in-patient hospitalisation for pre-existing diseases, which have to wait for two-four years. Aditya Birla and Manipal Cigna have specified day-1 OPD and other insurance policies’ documents can confirm the same.
Also read: Covid-19, what next?
Post-pandemic, virtual methods like e-consultation or Telemedicine consultation can also be accessed in the base policy itself and this option is highly suitable in the current period of high viral incidence rate.
OPD cover is either part of the base policy or provided as a purchasable add-on. Manipal Cigna’s base policy for ₹5 lakh sum insured comes with a ₹20,000 OPD cover per policy year. But OPD cover is mostly provided as an add-on. The add-on costs between ₹700 and ₹2,000 for physical consultation and unlimited telemedical consultation with empanelled doctors.
The importance of health insurance should have been the primary takeaway from the last two years. With increasing focus on OPD consultation as part of the care continuum and the infrastructure built around a ‘digital’ access to OPD consultation, OPD covers should also be a primary consideration of the everyday health insurance package.