Upgrade Your Insurance Policy to Cover OPD Costs

Optimising your health insurance and getting the best coverage is essential as healthcare is becoming expensive, and the out-of-pocket expenses are growing daily. Insurance companies offer many options to customise and address the medical needs of consumers.

You can upgrade to an insurance policy that offers cashless Out Patient Department (OPD) treatment, a guaranteed cumulative bonus, a daily cash rider and lower sub-limits. When your existing plan does not provide these cost-effective features, consider changing to an insurance plan that offers the following features/extra coverage from the same or a different health insurer:

• Cashless OPD, including diagnostic fees, professional fees, medical bills, dental treatments, treatments for fractures, minor surgeries, etc
• Guaranteed cumulative bonus
• Essential riders and a top-up plan

Cashless OPD

Basic health insurance plans cover only hospitalisation, while a significant part of healthcare costs is related to diagnostics, doctor consultations and medicines. An insurance policy with cashless OPD takes care of such expenses. It benefits those living with parents or young children prone to ailments or higher out-of-pocket expenses requiring over-the-counter medical tests or medicines.

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

Guaranteed cumulative bonus

Select a policy with a guaranteed cumulative bonus that protects a loss of cumulative bonus post-claim for the same premium. A few health plans offer a guaranteed cumulative bonus of 25-30% per year, raising to 200% of the sum insured, irrespective of the claim. However, you need to pay an extra premium when you opt for fresh coverage.

Also, choose an insurance policy offering a loyalty discount on the applicable premium after a few years of renewal. Some insurers offer additional discounts when the policy is renewed through the National Automated Clearing House or standing instruction by direct debit through a credit card or bank account.

Essential riders

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

Also, choose a policy offering restoration benefits when the insured sum is exhausted due to hospitalisation in the policy year. It is a good feature in a family floater plan. The family members continue to receive coverage on the restoration of the insured sum when the base cover of the floater is exhausted.

For any clarifications/feedback on the topic, please contact the writer at mayashree.acharya@clear.in