Should you go for OPD health subscription plans?
Premium- OPD subscription-based insurance can make treatments very affordable for you as it comes at a reasonable price
Outpatient care and treatment can sometimes prove to be very costly and thereby a risk to household savings. However, unlike many developed economies, most health policies in India do not cover Outpatient Department (OPD) services such as diagnostics and dental treatment. Regular health policies mainly offer cover for treatments that require hospitalization and are generally expensive.
Yogesh Agarwal, founder and CEO of Onsurity, an employee healthcare benefits platform, said that a health insurance subscription model can provide holistic health and wellness benefits for India’s missing middle. “We believe that a true subscription model will effectively cover both IPD (in-patient department) care and OPD costs. In that case, if you subscribe to a monthly health plan, you can get a holistic benefit. However, the services may vary based on the provider," he said.
Need for subscription model: ‘Health coverage’ generally implies coverage for IPD costs of hospitalization and emergency procedures. This is because the insurance sector has focused on these expenses alone. But there’s something flawed with this approach. One is unaware that OPD benefits are generally not available with regular health insurance.
Aniruddha Sen, co-founder of Kenko Health, says, “Up to 65% of all healthcare expenses during our lifetime are OPD costs pertaining to doctor consultations, lab tests, medicines, etc. If health insurance policies are unable to help meet a major chunk of our healthcare expenses, we need to rethink our very notion of health coverage."
He further said, “For this, we must draw attention to how such routine expenses make a sizable dent in the savings of an average middle income household in India. Many of these families don’t even have any health insurance policies because of their high annual premiums. The need of the hour is to make monthly health plans more accessible and comprehensive in the form of bite-sized subscriptions."
There are firms that offer subscription-based schemes. Kenko Health is one of them, but it pertinent to note here that it is not an insurer but a healthcare firm. It works with a combination of insurers, web aggregators, hospitals, pharmacies, labs, etc., and provide sachet-pricing health OPD plans. You can also get complimentary IPD coverage. These are tailor-made bundled insurance products offered on a monthly subscription basis and are designed to help you save on unforeseen medical expenditure.
Agarwal said, “The subscription model provides savings on treatment and diagnostics as preferential rates become applicable from quality healthcare providers. For instance, the prevailing rate for MRI at most diagnostic centres is ₹12,000 but it will cost you only around ₹6,000 through the subscription model."
Thus, the monthly subscription is reasonably priced and is very affordable.
Experts say a health OPD subscription can also help you save on IPD insurance costs. This is because OPD products such as diagnostics provide more health data points at a cheaper price and give valuable inputs for preventive care or in identifying diseases at an early stage and thereby helps save on IPD treatment. For instance, getting vaccinated against covid can protect you from severe complications and hospitalization, thereby avoiding major IPD costs. Regular and routine diagnostic tests (covered under OPD) can also save you from significant medical expenses in the future.
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How it works: You need to pay a subscription amount to get monthly benefits. There are a variety of subscription plans — ranging from ₹299 per month to ₹1,999 a month.
When you subscribe to any of these health plans, you need to sign in to the platform and fill details about your lifestyle, medical history, family’s medical history, and current ailments. A healthcare firm (such as Kenko Health) computes your health score based on these details. It’s a score with a range of 1-1,000. Sen said, “A score above 700 is considered ‘very good’ and that above 780 is ‘excellent’. But, a score below 400 might mean the person needs to improve on certain health parameters with the help of medical professionals."
Once you subscribe to the health plan, it will help you save anywhere between 20-90% on your medicines, lab tests and doctor visits alongside full complimentary coverage for hospitalizations ranging from 3-15 days.
Sen explains, let’s consider the hypothetical example of a 33-year-old man opting for the ₹999 family plan that covers routine expenses for himself, his wife, and two children and hospital treatment for 10 days. Let’s assume that their average expenses on medicines, lab tests and doctor visits (including purchase of regular drugs such as crocin and health supplements) add up to ₹3,000 per month, or ₹36,000 per year. By subscribing to a health plan, they get a flat 50% discount, helping them save ₹18,000 per year.
Mint Take: One should carefully opt for a subscription plan as you maynot get reimbursed for all OPD bills. For instance, the healthcare firm does not pay maternity OPD bills. Moreover, these firms typically exclude an offline general physician consultation. Agarwal said, “A well-known provider in this space offered this plan with offline general physician consulting benefits very recently and had to shut down operations later as it became an unviable business to sustain."Hence, make sure you research the subscription plans thoroughly before you start looking into bundling discounts to save your money. It may be possible to find other providers that can offer you the same benefits or even better coverage at a lower price.