How good is ICICI Lombard’s new OPD and Wellness Pilot?

ICICI Lombard recently launched a new OPD (outpatient) and wellness endorsement, “BeFit”. The add-on aims to provide 360-degree support outside of hospital healthcare, including preventative healthcare, wellness, and home care.

While other insurers also offer such coverage, this product includes everything that may be of interest to customers looking for a complete OPD solution. BeFit can be added to any of your existing ICICI Lombard health insurance plans to supplement basic health insurance.

Outpatient costs include medical consultation costs, pharmacy and diagnosis costs and treatment costs requiring one-day hospitalization. The frequent and non-critical nature of the charges excludes them from the coverage of basic health insurance policies. Home care, allowing basic ailments to be managed in the comfort of one’s home, is also excluded from basic health cover.

Product offer

ICICI Lombard’s BeFit has integrated its services across physicians, diagnostics, wellness coaches and consultants on a single interface available on ICICI Lombard’s IL Take Care mobile app. The add-on can provide access to consult with doctors, physically or virtually, through a network of around 11,000 doctors in 20 specialties in 20 cities, to begin with. The plan also offers advice on health issues, which also extends to psychiatric and mental health. Diagnostic and pharmacy services are also included in the endorsement with a network of approximately 1,000 diagnostics and pharmacies, as well as home delivery where applicable. The coverage also allows for minor surgery in day hospitalization, but available from other health insurers.

Runner also offers health and wellness management programs. While the former is optional for clients, it is necessitated by the plan, upon diagnosis of adverse lifestyle or health conditions. It includes a health management program with a personal health coach, dietary and nutrition consultants to monitor and improve the health of the insured. The wellness program does not intervene and is meant to encourage healthy behavior with reward points that translate into a discount on premium renewal or other services. Health management rewards and wellness rewards accumulate over a period, with each point equaling 25 paise.

Cashless and wide range of options

The price of the rider ranges from ₹297 to ₹6,558 with a total of six different options. The low-cost plan offers virtual consultations and other services such as counseling, ambulance assistance, preventive care, wellness and health management programs. These are available in all price ranges. The highest plan offers physical and virtual consultations, pharmacy and diagnostic services up to ₹5,000 per year, as well as physical therapy sessions.

As the network of doctors, diagnostics, pharmacies and other professionals/services are present in the BeFit network, the cashless settlement functionality is gaining importance. OPD coverages from other insurers also offer cashless benefits, but a dedicated OPD network is essential to obtaining benefits.

How it compares

For other insurers, specific OPD coverage is integrated into specific plans. While the basic health insurance provides an insured sum of ₹5 lakh at an average premium of ₹12,000 per year, OPD-specific policies are available at an annual premium of ₹12,000 to ₹16,000 per year .

Max Bupa Go Active Health Insurance offers OPD fees of up to ₹1,500 per year as a basic feature of the policy. At an additional ₹2,459, Wellness Cover can be purchased, which provides a 20% discount on annual premiums to meet your health goals. Universal Sampoo General Health Insurance Plan offers OPD coverage of ₹5,000 per year. Similarly, Star Comprehensive and Manipal Cigna Prohealth offer OPD covers of ₹1,200 and ₹500 per year respectively. The health check is offered by these plans but with different conditions; once a year with Max; up to ₹2,000 per year with Star and up to 1% of sum insured with Tata AIG Medicare. Most health insurance policies provide pre- and post-hospital care, as it is considered an extension of the continuum of hospital care.

Earnest L. Veasey