In an attempt to offer comprehensive coverage to policyholders, the best health insurance policies fund both inpatient and outpatient hospitalisation. Taking into account the medical inflation, this perk is a true financial leverage during times of health crisis.
However, acknowledging the difference between Inpatient and Outpatient Hospitalisation In Health Insurance, their benefits, and utilisation is crucial to tap into the full potential of your policy. This will also help you make an informed choice about your healthcare services.
Inpatient vs Outpatient Hospitalisation In Health Insurance
| Inpatient Hospitalisation | Outpatient Hospitalisation |
|---|---|
| In cases when the patient requires an overnight or more extended period of hospitalisation | In cases when the patient requires medical treatment that involves short-term hospitalisation (not overnight) or just doctor visitations. |
| Expensive charges are involved considering the complexity of treatments and procedures that the patient requires. | Mostly nominal charges are incurred since no long-term treatments/hospitalisation is involved. |
| Included in all health insurance policies | Included only in some health insurance plans as an in-built feature or as a rider. |
Inpatient Hospitalisation In Health Insurance
- What is Inpatient Hospitalisation?
Inpatient hospitalisation suggests cases of medical conditions where the policyholder has to be admitted to the hospital (planned/unplanned) and has to stay overnight (or for an extended period) for treatment/surgery/monitoring. He/She is put under the treatment care of doctors and nurses.
2. Types of inpatient hospitalisation
There are two types of inpatient hospitalisation -
- Emergency hospitalisation
Imagine - Mr. A is on his way home from the office and met with an accident. He has a couple of broken bones and some critical, near-fatal wounds. He is immediately rushed to the nearest hospital.
This is a case of emergency, unplanned hospitalisation. These cases also include conditions of trauma, accidents, and critical ailments.
- Planned hospitalisation
Say, Mr. X is on his scheduled health check-up for the year. His doctor diagnoses him with a cardiac condition that requires surgery within the next couple of months. Mr. X, searches for a specialist and arranges for a date of the surgery at his preferred hospital.
Such planned hospitalisations involved well-scheduled surgeries/treatments with specialists and offered policyholders the advantage of approaching their preferred medical centres.
- Elective procedure hospitalisation
Mr. X has been facing issues with his hips for some time now. His doctor suggests that he might need hip replacement surgery that would improve his quality of life. Mr. X clears his schedule and takes into consideration the possible recovery time before talking with his doctor to schedule the surgery.
With such hospitalisation, policyholders can get treated for their elective procedures, like kidney stone/appendix removal, cleft lip surgery, cosmetic surgery, etc.
3. Coverage for Inpatient Hospitalisation In Health Insurance Plans
All health insurance policies, in their base coverage offer funding for inpatient hospitalisation. The coverage in such cases includes -
- Room rent charges
- ICU charges
- Doctor’s fees
- Consumable coverage (with certain health insurance-ons)
- IV, medicine, prosthetics, etc.
4. What are the crucial hospitalisation coverages that you should seek in the best health insurance plans?
Well, the more a plan covers with reasonable premiums, the better, right? However, when choosing a health insurance plan, there are some inpatient coverages that you should prioritise -
- No room rent restrictions
- Coverage for consumables (even as a health insurance add-on, works)
- No disease-wise sub-limits on any procedures/surgeries.
- Critical illness coverage (as a rider works too)
- Road and air ambulance fee coverage
Outpatient Hospitalisation In Health Insurance?
- What is Outpatient Hospitalisation?
Outpatient hospitalisations are cases in which the policyholder requires medical treatments/care but that does not involve him/her getting admitted to stay the night. Such hospitalisations are required in the cases of less serious ailments that fetch no need for severe care or treatment, for example - cataract surgery, diagnostic tests, therapy sessions, etc.
2. Coverage for Outpatient Hospitalisation In Health Insurance Plans
Health insurance policies do not usually cover outpatient treatments (exceptions: daycare procedures) unless they have an in-built OPD coverage, or you have opted for an OPD add-on. The coverages usually include -
- Dental procedures
- Doctor visitations
- Diagnostic tests
- Chemotherapy
- Minor surgeries that do not require extensive professional care
- Dialysis
- Physiotherapy
- Counselling sessions, etc.
3. Should you opt for an OPD coverage in your health insurance policy?
You can avail of OPD coverage in your health insurance policy as an in-built feature or as a rider based on the insurer and the plan that you opt for. Now, while the best health insurers do offer such plans, whether you should avail it or not is another question. Here are some pointers that you need to factor in about OPD before you settle upon a plan -
- Nominal charges for OPD
In general, OPD treatments and procedures incur nominal charges as compared to those fetched by inpatient hospitalisations. So, it won’t burn a hole in your savings if you pay this off from your pocket.
- Caps on OPD coverage
OPD coverage in health insurance plans comes with caps on the amount and the types of ailments funded for.
For example, plans often have restrictions about the number of doctor visits they would cover and carry caps on the amount/frequency of visits.
More often than not, the amount isn’t adequate and you end up paying for the fees yourself as it is.
- High premiums
Insurers are well aware that you are most likely to file claims under OPD coverage if they extend the benefit under their policies. Hence, to secure their financial stability, they safeguard themselves by charging high premiums for plans that offer OPD coverage.
And despite the high premiums, there are still caps and restrictions on the perk, forcing you to pay for the OPD procedures after all.
To summarise, it’s best to not reach for plans that cover OPD benefits because, in the end, your OPD charges wouldn’t hurt your savings as much as the premiums would.
Difference Between Inpatient & Outpatient Hospitalisation In Health Insurance
| FEATURES | Inpatient Hospitalisation In Health Insurance | Outpatient Hospitalisation In Health Insurance |
|---|---|---|
| Definition | When a patient requires an overnight or extensive period of hospitalisation due to medical conditions involving trauma, accident, or critical/chronic ailments. | When an individual requires medical attention that involves short-term hospitalisation (a few hours) or merely doctor visitations. |
| Types of procedures covered | Complicated surgeries/procedures, long-term health monitoring, and round-the-clock professional medical care. | Simple health issues that require visitations to physicians, diagnostic tests, short-term medications, etc. |
| Charges involved | Since comprehensive medical care is involved along with hospital charges (room rent, ICU charges, etc.), the bills are high. | Requires minimal health service care and thus, incurs lower charges. |
| Required medical specialisation | Requires healthcare specialists, specialised and cutting-edge medical equipment, and constant health monitoring. | Calls for diagnostic services, OPD treatments, and general physicians (generally). |
| Health insurance policy coverage | All health insurance policies cover inpatient hospitalisation charges. | Only some health insurance policies cover inpatient hospitalisation charges as an in-built feature or as an add-on. |
| Best health insurance plans available |
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Conclusion
As stated before, while inpatient hospitalisation is a by-default coverage in health insurance plans, OPDs are available only in some health insurance plans as add-ons or in-built forms. And, while OPD coverages are becoming quite popular in the market, what you need to focus on regarding this feature is, considering the spike in premium that it fetches and the caps on the annual sum assigned (and also a limit/amount for total no. of visits per year), is it really worth it?