Out of pocket expenses in health insurance

  • postauthorRaj
  • postdateMarch 6, 2023
  • postreadtime3 min read
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Out of pocket expenses in health insurance: COVID-19 treatment has underlined the importance of having health insurance coverage. While many people did have access to health insurance, the hefty medical bills forced them to pay out of pocket as a standard health policy does not offer coverage for consumables, deductibles, etc. As per IRDA, out of pocket expenses makeup up 62% of the total healthcare costs in India which is one of the highest in the world.

Despite having health insurance, it is important to know that your insurer will not provide coverage in all cases, and you might have to spend out of your pocket based on the policy terms and conditions. Read on to know all about out-of-pocket expenses in health insurance and how you can ensure your insurer covers it all. 

What are out of pocket expenses in health insurance? 

As the name suggests, out of pocket expenses refer to the medical costs that you have to pay out of your pocket. These costs are not covered under your health insurance policy. These may refer to the cost of consumables (PPE kits, masks), deductible (the amount you are required to pay before the health insurance coverage kicks in), co-payment (expenses you share with the insurance company), and sub-limit (room rent).  

Instances when cashless health insurance policies incur out of pocket expenses 

Hospitalisation in case the expenses are higher than the sum insured. Medical treatments such as cancer, maternity, etc. attract heavy per-day costs which lead to an increase in exhausting the sum insured limit quickly. 

Non-payable items are mentioned in the policy document. These include administrative and consumable expenses.  

Insurance companies provide OPD cover only for 30 days i.e. pre-hospitalisation and 60 days in case of post hospitalisation. Any costs incurred beyond this should be borne by the policyholder. 

How do reduce out-of-pocket expenses in health insurance? 

Given below are a few ways by which you can reduce out of pocket expenses in health insurance. 

Choose a high amount of coverage: Based on the city you live in; your medical history and age opt for a high sum insured. In metro cities, the cost of medical expenses is higher than in tier II and tier III cities. In meteor cities, having a sum insured of 15-20 lakh is recommended. 

Policy terms and conditions: Read policy terms and conditions carefully. Check for deductibles, co-pay, sub-limits for specific treatments, room rent, etc. Understand the term carefully and only then  

Other ways to save: A sizeable portion of the costs you will have to pay for our doctor consultations and medicines if you visit the OPD. Therefore, therefore you should pick a plan that offers discounts on these, giving you more ways to save.  

Here is why you should choose Onsurity group health membership 

If you are a small business or a start-up, choosing Onsurity group health membership can help you reap great benefits. Our affordable healthcare plans offer you more than just health insurance coverage. With Onsurity, provide your employees access to teleconsultation, pharmacy, and diagnostic discounts. Onsurity’s good doctors’ team is also here to help employees with their hospitalisation and claims process. The team is a concierge service that helps employees understand all the minute details. From whether a treatment is covered, to the possible out-of-pocket expenses they will have, Good Doctors know everything about your group health insurance plan with Onsurity’s wellness membership. The team can also advise employees on things like proportionate deductions so that they make an informed choice about their hospitalisation. The membership starts only at Rs. 145/month*.  

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