9 Methods To Optimise Your Health Insurance Coverage And Lower Out-Of-Pocket Medical Costs

A majority of healthcare spending in India is out-of-pocket. A lot of people choose an inadequate sum insured. Of course, the low prevalence of health insurance in the nation is one of the key causes. The factors contributing to high OOPEs (Out-of-Pocket-Expenses) include outpatient department (OPD) costs, which are not typically covered by health insurance plans, as well as high co-pay and sub-limits in health insurance, which force consumers to foot the rest of the bill. *

How may this financial load of healthcare be lessened? By using a two-pronged strategy, you may reduce expenses that you will inevitably have to pay out of pocket while simultaneously maximising your health insurance benefits to cover the majority of your medical bills.

  1. Non-hospital diagnostic centres should be used.

It is a good idea to have pricey radiological procedures, such as MRIs, CT scans, ultrasounds, or even X-rays, performed at private imaging centres or government hospitals rather than a private hospital if you haven’t been admitted to the facility already.

  1. Get generic medications

Avoid purchasing medications from hospital pharmacies or choosing branded medications is an easy approach to saving OOP costs. Even when a lower potency, less expensive antibiotic will work, clinicians recommend very high potency antibiotics, which are more expensive, in the absence of protocol. *

  1. Get sufficient health insurance.

It is important to obtain health insurance plans for family that suits one’s requirements and has a sufficient sum insured. The amount should be determined by your age, the size of your family, where you live, and your medical history.

  1. Be discreet about the type of hospital room & other outlays regulator of insurance.

Some non-medical costs that insurance companies are not required to cover while a patient is hospitalised have been set aside by IRDAI. For the people who have insurance, there are things and non-medical expenses that are generally excluded from the scope of insurance. #

  1. Preferred cashless hospitals should be used.

Choosing a hospital in the insurance company’s preferred network is another way to lower your OOP costs. Consumers benefit from the insurers’ agreements with various hospitals since they receive lower prices and bundles for procedures. *

  1. Select plans with low co-pay & deductible as an option

The premium may be lower if you choose a health insurance plan with a high co-pay or deductible, but you will have to pay more out of cash in the long run, especially if you don’t have a basic plan. This is so that the co-pay or deductible can be satisfied before the insurance starts to pay. *

  1. Get riders if your plan is outdated.

Transferring to a new, more comprehensive plan may be a good idea if you have an outdated plan with increasing out-of-pocket expenses. Another choice is to choose extras and riders that offer better coverage.

  1. Get concessionsfor online appointments and health services

If you need to schedule a doctor’s appointment in a hospital, try to do so via the hospital website or app, as they may provide a concession on online booking and payment, reducing your OOP expense. For instance, the online booking service at a hospital could offer a 10% concession on scheduling appointments and making payments in advance. ##

  1. Upgrade to plans that cover OPD, daycare, daily cash, and sub-limits.

Insurance covers only hospitalisation, while more than 50% of the total healthcare expenditure is related to OPD, spent on doctor consultations, drugs, and diagnostics. Try to choose plans that have fewer sub-limits, such as room rent categories, and cover OPD (no hospitalisation) and childcare treatments. * ##

* Standard T&C Apply

** Currently, there are 2 tax regimes in India – new and old. To get the tax benefit you desire, choose the correct one after consulting an expert. You can opt for a regime change during the next financial year.

# Visit the official website of IRDAI for further details.

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. Standard T&C apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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