ICICI Lombard recently launched a new OPD (outpatient) and Wellness rider, ‘BeFit’. The add-on aims to provide 360-degree support outside of in-patient healthcare, including preventive healthcare, wellness, home healthcare.

While other insurers too offer such covers, this product includes everything that can be of interest to customers looking for a comprehensive OPD solution. BeFit can be added to any of your existing health insurance plans from ICICI Lombard to complement basic health insurance.

Outpatient charges include fees for doctor consultations, pharmacy and diagnostic charges and expenses on treatments that require hospitalisation for a day. The frequent and non-critical nature of the charges keep them out of coverage in basic health insurance policies. Home healthcare, to manage basic health ailments from the comfort of home, is also excluded under basic health covers.

Product offering

ICICI Lombard’s BeFit has integrated its services across physicians, diagnostics, wellness coaches and consultants on a single interface available on ICICI Lombard’s IL Take Care mobile application. The add-on can provide access to consultation with doctors, either physically or virtually across a network of around 11,000 doctors across 20 specialities present in 20 cities, to begin with. The plan also offers counselling on health issues, which extends to psychiatric and mental health as well. Diagnostics and pharmacy benefits are also included in the rider with a network of around 1,000 diagnostics and pharmacies, along with home delivery in cases where applicable. The cover also allows for minor surgical procedures on day-care basis, but available across other health insurers.

The rider also provides health management and wellness programmes. While the former is optional for customers, it is necessitated by the plan, upon diagnosis of lifestyle or adverse health conditions. It includes health management programme with a personal health coach, diet and nutrition consultants to monitor and improve the health of the insured. The wellness programme is non-intervening and is supposed to incentivise healthy behaviour with reward points that translate into a discount on premium renewal or other services. Health management rewards and wellness rewards accrue over a period with each point equivalent to 25 paise.

Cashless and wide range of options

The pricing of the rider ranges from ₹297 to ₹6,558 with a total of six different options. The inexpensive plan offers virtual consultations and other services such as counselling, ambulance assistance, preventive care, well-being, and health management programmes. These are available across price ranges. The highest plan offers physical and virtual consultations, pharmacy and diagnostics services of up to ₹5,000 per year, and physiotherapy sessions as well.

As the network of doctors, diagnostics, pharmacies and other professionals/services is present in the BeFit network, the cashless settlement feature gains prominence. OPD covers from other insurers also offer cashless benefit, but a network dedicated to OPD is key for getting benefits.

How it compares

For other insurance providers, OPD specific covers are built into specific plans. While basic health insurance provides a sum assured of ₹5 lakh for an average premium of ₹12,000 per year, OPD-specific policies are available at yearly premium of ₹12,000 to ₹16,000 per annum.

Max Bupa Go Active health insurance offers OPD charges of up to ₹1,500 per year as the basic feature of the policy. With an add-on for ₹2,459, a wellness cover can be purchased, which provides a discount of 20 per cent on yearly premiums on meeting your health goals. Universal Sampoo general insurance health plan offers OPD cover of ₹5,000 per year. Similarly, Star Comprehensive and Manipal Cigna Prohealth, offer OPD covers of ₹1,200 and ₹500 per year respectively. Health check-up is offered by these plans but with different conditions; once every year with Max; up to ₹2,000 per year with Star and up to 1 per cent of sum assured with Tata AIG Medicare. Most health insurance policies offer pre and post hospitalisation care, as it is seen as an extension of in-patient treatment continuum.