How the scope of medical health insurance has expanded to be more inclusive


Indian medical health insurance market, although still underpenetrated, is well on its approach to ensuring maximum protection for the masses. The pandemic-led urgency has undeniably been a decisive factor propelling this growth. As per the information by a Union Finance Ministry’s research paper in May 2022, the pre-pandemic medical health insurance market in India had been showing a gentle growth of around 24% CAGR. Nonetheless, the expansion rate jumped to 34% throughout the Covid-19 period. Not only this, the figures also indicated that as in comparison with 2020-21, the overall medical health insurance premium collected in India increased significantly by 25% in 2021-22.

Aside from Covid-19, aspects like medical inflation and a steep rise in non-Covid diseases too have made people realise the critical need for having adequate medical health insurance. To efficiently cater to this need, the medical health insurance industry is consistently evolving and innovating to solid a wider safety net for all. Recent-age product offerings coupled with progressive regulatory policies are crucial in driving this paradigm shift.

Here’s highlighting different facets of medical health insurance which are making the Indian medical health insurance industry more conducive to further growth.

OPD coverage in medical health insurance

Not only hospitalisation, even out-patient-department or OPD charges comprise a good portion of medical bills for the typical Indian. Diagnostic tests, doctor consultations and check-ups are an inevitable a part of healthcare, which might get quite expensive. While this aspect wasn’t a component of medical health insurance earlier, new-age policies are taking this cost into consideration and providing coverage for a similar. More importantly, these plans not only cover physical doctor consultations but in addition virtual consultations. Telemedicine has been an imperative a part of healthcare throughout the pandemic and even made its approach to medical health insurance coverage after the rules by IRDAI. While OPD coverage overall is a hugely positive effort in ensuring higher protection at scale, including virtual consultations takes it a step forward in ensuring convenience, safety and accessibility.

Enhanced maternity advantages 

Experiencing parenthood is an emotion like none other. Nonetheless, apart from being joyful, it may well even be an expensive affair, which makes maternity coverage a crucial aspect of medical health insurance. Maternity profit shields you against exorbitant costs while pregnant, tests, scans and delivery, and even beyond that with newborn care coverage. The stats indicate that in metro cities the general cost of maternity can run as high as Rs 80,000- 1 lakh. Relying only on corporate policy generally is a costly mistake here because the sum insured in these policies won’t be sufficient to cover the bills. Maternity cover is specially designed to bear such expenses and is a must have for soon-to-be parents. Recent plans out there include a waiting period as little as 12 months and other great features, which you possibly can go for right once you start planning a family.

Covering pre-existing diseases

This aspect of medical health insurance is riddled with misconceptions – starting from non-coverage to restrictions. In a rustic where conditions like diabetes and hypertension are prevalent across all age groups, pre-existing disease coverage becomes a non-negotiable a part of medical health insurance. Subsequently, the scope of policies has been expanded to cover many such conditions right from day one. While for a few of them, there may be an extended waiting period applied, the coverage starts immediately after it’s over. On this case, one can buy a policy with suitable features well upfront in order that they comfortably sail through the waiting period which might range from two to 4 years, depending on the condition. With the commonly relaxed underwriting norms now, it may well be even lower as well.

Domiciliary treatment coverage

The outbreak of Covid gave approach to many breakthrough policies to make sure maximum insurance coverage. One such move by the IRDAI was domiciliary or homecare treatment coverage under medical health insurance. The deadly second wave of the pandemic witnessed innumerable cases of hospital bed shortage and other people choosing home care as an alternative. Keeping in view this case, if the insured has opted for domiciliary coverage within the policy, they will get the treatment expenses covered under their policy. The condition is that the treatment have to be prescribed by a registered medical practitioner.

Inclusion of mental health coverage

For a long time, mental health has been a clandestine conversation in India. Here also, the pandemic acted as a catalyst in breaking the taboo and brought the problem to the forefront. The IRDAI further supported the cause by issuing a directive to incorporate mental health coverage under medical health insurance policies. The past two years of living with Covid-19 have been detrimental to the collective mental health of the nation. Right from losing family members to limited social interactions to financial adversity to anxiety and fear of the disease, there have been ample reasons for poor mental health, especially during this span. So, this inclusion covers a hugely critical aspect of medical health insurance.



Views expressed above are the writer’s own.


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