Difference between OPD and IPD [Treatment + Insurance]
Learn the meaning of OPD and IPD, its differences and claim process.
October 31, 2023
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There are more than 20 health insurance companies in India and all of them offer varied types of group mediclaim insurance policy for employees. So it becomes difficult to compare and select one. Our insurance experts say that pricing shouldn’t be the only deciding factor when it comes to group medical cover. The ultimate focus should be on providing the best employee insurance experience.
At the end of the day, any group health policy is aimed at a good claim experience. And for a claim to be seamless aspects like claim settlement ratio, TPA, network hospitals and cashless facility have to be the best.
Here are few factors you can use to compare group medical policies. These 6 are the significant parameters you would need to compare two group health insurance policies.
Health insurance costs are inflating at the rate of 17-20% annually. You have to consider the coverage and sum insured that is offered in the market and match it. Offering a sum insured of 1 to 2 lakhs won’t make the cut these days. The average is 3 to 5 lakhs. You have to offer extensive coverage with reasonable sub-limits or no sub-limits, no copay, maternity cover, and also free doctor consultations.
Claim settlement ratio determines how many claims are settled by the insurer yearly. Always go for a company that has a good claim settlement ratio. A claim settlement ratio above 80% is good. The claim settlement ratio directly impacts your claim experience. So, a good claim settlement ratio indicates high chances of your group mediclaim policy claim being settled.
Claim Settlement Ratio (CSR) = Claims settled in a year/Claims received in a year * 100
Group health Insurance Third Party Administrator or TPA are the ones who will help you with the claims during the time of hospitalization. They are the middlemen between you and the insurer. They help you with filing, tracking claims and getting the right information regarding your policy. In some cases, insurers don’t work with TPA and instead have an in-house claim settlement department. So, always check if the plan has a external TPA or an in-house TPA for claim settlements
Network hospitals are the hospitals that are tied up with the insurer for cashless claims. The more the number of hospitals, the better for your employees. Cashless claims enable a seamless and time-efficient claims process. And cashless claims are only possible in network hospitals.
Incurred Claim Ratio or ICR is one of the factors that determine the credibility of an insurance company and is also an important factor to check before comparing two health insurance companies. While taking Incurred Claim Ratio into account, check for the average Incurred Claim Ratio of all health insurance companies and go for the one that is closest to this average.
Incurred Claim Ratio is calculated as Incurred Claim Ratio/ICR = Amount settled as claims/Amount collected as premiums.
Last but not the least, while doing group health insurance plan comparisons always check customer experience and reviews online. This determines how the company will respond to your queries and future claims. Also, check for the people’s opinion because if the customers are not happy then the insurance service or customer support is not up to the mark.
With Pazcare, you can get quotes from all top insurers and compare it easily. You don't have to contact insurers and wait for their quote and offerings. We will get it for you within 24 hours after you tell us your requirements. You can make an informed decision for your team.
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