Why cashless OPD is the best way to reduce out-of-pocket expenses for employees

Many employee’s put-off getting medical treatment unless absolutely necessary to avoid exorbitant out-of-pocket expenses that are not covered under their medical insurance. As per the Insurance Regulatory and Development Authority of India (IRDAI), out-of-pocket medical expenses make up 62% of total healthcare costs in India- one of the highest in the world. Further, inadequacies in health insurance coverage are one of the prime reasons for such exorbitant medical expenses. Up until now, corporate health benefits and insurance have been synonymous with secondary care ie, hospitalisation. But rising healthcare costs, increasing incidence of diseases and the global pandemic have spurred the need for OPD (Outpatient Department) schemes. Moreover, seamless and cashless OPD programs are what fast-paced lifestyles currently demand.

Cashless OPD covers a slew of medical expenses such as consultation, diagnostic tests, medicines, vision and dental treatment, etc. The foray of HealthTech and InsurTech start-ups into the healthcare industry has brought forth innovations such as teleconsultation, e-prescriptions, cashless OPD and seamless claim settlement that are bringing down out-of-pocket expenses significantly. Owing to cashless OPD, employees, as well as their families, are capitalizing on cashless treatment without the need for 24-hour hospitalization.

Provision for outpatient expenses

One of the most frequently borne expense OPD services. To minimize out-of-pocket medical expenses, many organizations are providing their employees comprehensive OPD coverage plans that insure against doctor consultation, lab tests, pre and post-hospitalization expenses, health check-ups and medicines, among others. Given the wide coverage of OPD Schemes, employees and their families can reap the benefit of lowered out-of-pocket expenses, which are not under the purview of most insurance and Mediclaim policies.

Lucrative tax benefits

By providing cashless OPD cover, organizations can also help their employees claim tax benefits. As compared to regular health plans, plans with OPD cover are eligible for exemption under 80D on the amount of premium paid. Employees can claim for medical expenses not paid under regular health insurance policies for tax exemption. As a result, employees or their family members who spend a sizeable amount on pharmacy bills or are chronic patients can lower their medical expenses with OPD cover.

Multiple claims benefit

In recent times, health inflation has risen from 3.8% in 2019 to 8.4% in 2021 due to which several people are avoiding visiting OPD centers. However, employees with cashless OPD cover and their family members can avail multiple claims during the policy period upon every visit to the doctor, diagnostic center or pharmacy. Due to their comprehensive coverage, cashless OPD schemes cover a large number of transactions which helps to reduce the financial burden and medical inflation in the country.

Simplified chronic disease management

Many employees or their family members suffer from chronic health conditions like asthma, hypertension, cholesterol and diabetes. Managing chronic disease often exacerbates the cost of living due to routine expenses on check-ups, medicines and health tests. According to IRDAI, 40% of total health claims are processed as reimbursements which are time-consuming and expensive. With cashless OPD cover, employees can get access to specialist doctors, diagnostic labs, pharmacies and in times of emergency cashless hospitalisation, thereby reducing their financial burden and simplifying chronic disease management.

Opportunity to safeguard savings

Given the rising medical inflation in India, employees end up paying out of their pocket and waiting for reimbursements. Especially during the Covid-19 pandemic, many employees and their family members had to bear extreme financial burdens with inadequate or no insurance coverage. Many families even lost their entire life savings and ended up borrowing expensive loans to meet their medical expenses. Keeping in mind the changing times and needs, cashless OPDs can help employees safeguard their savings and make the most of their employee health benefits.

wrap up

With ever-increasing medical inflation and healthcare needs in the country, consumers are looking for a holistic health cover that not only covers their secondary treatment but also day-to-day primary and OPD expenses. At a time like this, cashless OPD is emerging as a one-stop solution for consumers’ short-term and long-term needs, helping to reduce their financial burden and minimizing their out-of-pocket expenses. As employees are becoming more financially aware, organizations should help them become financially empowered as well with cashless OPD solutions. Cashless OPD will give rise to a frictionless consumer experience, thereby leapfrogging the gaps in our healthcare and insurance industry.



Views expressed above are the author’s own.



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