Why cashless OPD is the best way to reduce employee out-of-pocket costs, Health News, ET HealthWorld

To Varun Gera

Did you know that 60-80% of Indians’ healthcare costs are spent on drug bills, medicines and regular medical bills, not hospital bills? will pass without hospitalization.

On the contrary, the average Indian household spends far more on pharmaceuticals in a year. India has the highest out-of-pocket costs and she is one of the most burdened countries, directly contributing to the high incidence of catastrophic spending. Many have monthly medical bills that may be paid directly out of pocket. health care costs are 30% higher than those states.

Wouldn’t it be nice if insurance could pay for out-of-pocket medical costs? India is now trying to make OPD a part of mainstream health insurance. OPD in health insurance helps patients avoid exorbitant outpatient costs, ensure robust financial protection for their care, improve healthcare infrastructure and health awareness, and optimize spending.

The inclusion of OPD in insurance will have a significant impact on preventive care, improve the country’s overall health index, and help build key healthcare infrastructure. Companies and employees typically become early adopters whenever a new product or technology comes out. Cashless OPD not only facilitates access to primary care, but also helps bring financial benefits to employers and employees.

Health care inflation is currently 15%, but typical inflation is 6-7%. This means that while our income is expected to grow at half the pace, the cost of medical expenses is expected to be higher, hence the need for his OPD cover in our health insurance scheme. Sex is a necessity of time. Government intervention is the only way to avoid skyrocketing health care costs.

To be exact It’s OPD cthat’s all?

Outpatient medical insurance is insurance for outpatient departments, and it compensates for expenses such as medical examination fees, medicine fees, dental treatment, medical examinations, and examinations. These costs may seem small when compared to hospitalization, but over time add up to a huge amount. Health insurance with OPD guarantees additional financial protection. However, OPD health insurance companies may have sub-limits on the amount insured against expenses. OPD insurance protects you from seemingly small but exorbitant expenses.

Our modern sedentary lifestyle is accompanied by a variety of chronic diseases that have a significant impact on our budgets. An OPD insurance plan ensures that your daily medical expenses are covered without a big financial burden. The lack of organized medical records also requires OPD coverage to become the norm. This ensures policyholders receive the best outpatient care without the hassle of operational deficiencies.

Advantages of Cashless OPD Allowance for hospital expenses

To minimize out-of-pocket medical costs, many organizations offer their employees comprehensive OPD coverage plans that cover doctor visits, lab tests, hospital bills, physical exams, medications, and more. . Due to the wide coverage of the OPD scheme, employees benefit from reduced out-of-pocket costs that are outside the scope of most insurance and mediclaim policies.

beneficial tax benefits

In offering insurance for cashless OPD, companies can also help their employees apply for tax incentives. Compared to other health plans, plans with OPD coverage are eligible for a Section 80D waiver on the full amount of premiums paid. As a result, OPD coverage can reduce healthcare costs for employees and chronic patients who spend a lot of money on drug bills.

Multiple billing benefits

These days, with rising health inflation, many people avoid rushing to visit an OPD center. However, cashless OPD-eligible employees and their families can take advantage of multiple charges each time they visit a doctor, diagnostic center, or pharmacy during the policy period. With comprehensive coverage, cashless OPD policies cover many types of transactions, ultimately helping reduce financial burden and medical inflation.

Simplify chronic disease management

Many Indians suffer from chronic health conditions such as heart disease, high blood pressure, asthma, cholesterol and diabetes. often increases. According to IRDAI[4], 40% of all health claims are processed as refunds, which is time-consuming and expensive. His cashless OPD cover provides employees with access to specialist physicians, diagnostic labs, pharmacies and cashless hospitalization, thus reducing financial burden and simplifying chronic disease management.

Opportunity to protect savings

There is no doubt that medical inflation is rising in India. Employees end up paying out of their own pocket and waiting for a refund. The COVID-19 pandemic has made it clear that many employees are uninsured, resulting in an extreme financial burden. Many families lost all their lifetime savings and took out expensive loans to deal with mounting health problems. Cashless OPD helps employees protect their savings and maximize their health benefits.

After COVID-19, Indian businesses are now realizing how important health insurance is. To keep employees healthy, the focus has shifted to things like regular health checks and pharmacy benefits.

Only about 10-12% of Indians have private health insurance. OPD costs account for his 62% of total annual medical expenses, but regular insurance only covers hospitalization. The additional OPD Cover policy gives some leeway, but not enough to cover daily out-of-pocket medical expenses. With the Covid threat still hanging over us, we expect the costs of OPD visits to rise further.

Employers now know that health insurance does not stop at just covering hospital costs, as the pandemic presents and uncertainty rises. His OPD service, which was a secondary focus, is now starting to gain more attention.

The need for primary health insurance and the need for a system that can provide health coverage from the start, even before hospitalization, has put OPD services into the spotlight compared to hospitalization costs.

Cashless OPD is also driving the adoption of digital platforms. The digital platform allows users to easily find network his providers, make OPD appointments, checkups, scans, etc., and view prescriptions and reports all on his one app or her web page. . Having all the records in one place gives you longitudinal data points for your users over a longer time frame, giving you better insight into your users’ health profile. This unlocks the benefits of supervised care and has proven to reduce the overall out-of-pocket burden for users over time.

Varun Gera, Founder and CEO, HealthAssure

(Disclaimer: The views expressed are those of the author only and are not necessarily endorsed by ETHealthworld. is not responsible for any damages caused to individuals/organizations, directly or indirectly. not.)

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