I am a 38-year-old IT professional looking for health insurance. I have backache and dental issues and want to cover dental care and physiotherapy primarily. I also want health cover for my wife and kids for routine doctor visits. I am facing difficulty in finding the right product. Please guide me on how I can go about it.

Vikas

A comprehensive health insurance policy will bridge the gap between expenses related to in-patient hospitalisation and outpatient expenses. You can either buy OPD coverage as a built-in base plan, or as a rider with the base policy. Medical inflation has increased costs of all treatments.

Today, outpatient care, such as consultation charges, medicine bills, diagnostics tests and dental bills come at a significant cost. One cannot do without these essential treatments. Over time, this builds up to a huge cost burden. OPD plans offer different levels of coverage, ranging from teleconsultation, physical consultation to diagnostics and cover for pharmacy bills and lab test. These plans offer unlimited consultations with general physicians and specialists. Look for a policy that also covers pre-existing diseases.

Out-of-pocket expenses

In India, more than 65 per cent of all healthcare costs relate to outpatient expenses, which include doctor consultation charges, medicine bills, lab tests, etc. The customer, while choosing a policy, can also avail unlimited virtual teleconsultations, unlimited in-clinic consultation, pharmacy expenses and diagnostic tests up to the sum insured in any of the networked facilities and cashless.

Paperless service, discounts

Some companies offer cashless services and facilitate delivery of medicines and lab test results in a paperless manner through iapps. You can place a request for any of the services, such as booking an appointment with the doctor or ordering from pharmacy or visiting labs for diagnostics through the app.

Some plans also offer discounts for medicines through the insurance companies’ app, with discounts of 5-15 per cent. Diagnostic discounts are also available in the range of 15-30 per cent.

Focus on well-being

Choose insurance companies that invest in wellness, wherein they guide customers on ways to stay healthy and provide measures to avoid sickness. Ultimately, staying healthy is a win-win for you, your family and the insurance company. Routine health check-ups, vaccinations, advice on staying fit and eating healthy can all augment your general well-being.

Finally, a key factor to examine before buying an OPD plan is that there should be many empanelled doctors for quick consultation. Next, you must look at the coverage for overall and per consultation OPD treatment, as it should be enough to cover consultation costs, medicines and lab tests. A basic health insurance policy covers only hospitalisation costs, whereas OPD plans provide an additional layer of coverage that is especially useful in cases where a person has any pre-existing condition or lower immunity. There is a definite need to have such a comprehensive health plan that covers not only hospitalisation but also OPD expenses.

The writer is CEO at Star Health

Send your queries to insurancequeries@thehindu.co.in 

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