This is a very common question which we come across from our customers. In fact those who are familiar with USA or are returning from there find it very strange that most of the Indian insurance companies have products which do not cover OPD.
The exceptions are;
ICICI Lombard’s “Health Advantage Plus” and
Apollo Munich’s “Maxima” Health Insurance plan.
ICICI Lombard’s Health Advantage Plus covers OPD expenses from the first day of the policy. The objective of this policy is that policy holders can enjoy maximum benefit under Section 80D as per applicable tax laws. It also offers/ covers all OPD expenses i.e. consulting, tests or medicines.
In recent times, there has been a rise in the number of Caesarian section births. Increasingly we see more complicated deliveries, a series of pre-natal tests and medication which have resulted in higher childbirth expenses. Health insurance with OPD cover is thus beneficial for women during pregnancy and childbirth. ICICI Lombard provides maternity cover as part of the Health Advantage Plus policy.
The OPD cover may vary from Rs. 2,000 to Rs. 10,000 depending on the plan opted and the age profile of policy holder.
One can claim OPD charges only once during the policy term so one has to keep all the bills paid safely to get the reimbursements as and when the limit is reached.
The Apollo Munich’s Maxima benefits includes , cash- less OPD expenses across trusted network of pharmacies for pharmacy bills, diagnostic centers for diagnostic tests and annual health check-up, dental and optical care centers for contact lenses, spectacles and dental treatments along with consultation with family doctors.
The maximum benefit allowable for 1 adult is Rs. 8,500 [350*3 + 500*1 + 1,000 + 2,000 + 1,000 + 1,000 + 2,000(estimated)]
In addition, both the policies do not allow, an insured person to claim OPD cost within 90 days of commencement of the policy.
If we go for a normal health insurance policy, the premium paid is much less compared to these policies; as a result we end up paying more than the benefits we may receive.
Let us see the choice with examples:
Example 1:
Mr. X aged 30 years buys individual Health Advantage Plus plan from ICICI
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 16,545
Less: Tax saved : Rs. 4,964 (30%)
Net premium : Rs. 11,581
Now if he takes normal healthcare policy from New India
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 3,871
Less: Tax saved : Rs. 1,161(30%)
Net premium : Rs. 2,710
So, to avail OPD coverage of Rs. 8,800 (which he will not be able to claim without unnecessary visits etc.) he pays a premium of Rs. 8,871 extra.
Example 2:
Mr. X aged 30 years buys individual Maxima plan from Apollo:
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 15,216
Less: Tax saved : Rs. 4,565 (30%)
Net premium : Rs. 10,651
Now if he takes normal healthcare policy from New India:
Sum Insured : Rs. 3,00,000
Premium paid : Rs. 3,871
Less: Tax saved : Rs. 1,161 (30%)
Net premium : Rs. 2,710
So, to avail OPD coverage of Rs. 8,500 (which he will not be able to claim without unnecessary visits etc.) he pays a premium of Rs. 7,941 extra.
The conclusion drawn is by having these policies you are getting the benefit in the ratio of 1:1 only.
10 comments:
Do you know about any such policy for parents where in OPD expenses are covered?
Do, does this mean there is no advantage to avail such plans, as they do not offer anything extra?
Is there any provision of including new born under health insurance? Pls advise?
You have to express more your opinion to attract more readers, because just a video or plain text without any personal approach is not that valuable. But it is just form my point of view
hiya
great forum lots of lovely people just what i need
hopefully this is just what im looking for looks like i have a lot to read.
irajiv
Yes Max Bupa covers and that too without any payment till the renewal date( at that time you pay for the new born also)
Anon
Yes not much benefit in going for policy with OPD benefit.
OPD for Parents - Yes Max Bupa policy for Rs 20 lakhs gives you OPD for Rs 15000
I am being appreciated for very frank opinions by many people who send emails and call me on phone.
Anon
Thanks for the compliments
Great help, I am new to this site, but learn a lot. Auto insurance is a funny thing. Each state has different rules and regulations on how auto insurance coverage should work. Despite all these laws and regulations, consumers have power over their coverage. Here are three items that your auto insurance agent won’t tell you when you sign the dotted line: 1. Rates are like fads, they are always changing Auto insurance rates are in a constant state of chang
Dear Sir,
I am a public sector retired employee. In our organization, Hospitalization is only covered. No cost of day to day treatment such as OPD, Phamacy etc. which form the major part of treatment are covered as per the policy of corporation.
Please guide us
regards
sks3010gmail.com
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