51% increase in companies offering OPD benefits compared to 2019: Survey

Among the companies that provide OPD benefits, 88 percent of participants are providing consultations with doctors, followed by dental benefits at 83% and diagnostics (such as X-rays, MRIs) at 80%

Eight in 10 companies in corporate India have increased their spending on well-being in 2023 compared to 2019 while two in three firms believe unhealthy employees have a direct impact on business financials, according to Aon India Primary Care Benefits Report 2023 that mapped 250 companies.

The report, which evaluates investments in primary care and outpatient benefits in the wake of the COVID-19 pandemic, found a 51 percent increase in companies offering outpatient department (OPD) benefits compared to 2019. 

Among the hi-tech and consulting industries and small and medium-sized companies, the provision of primary care benefits more than doubled and tripled in this period, respectively. 

What benefits are employers considering under outpatient care?

Among the companies that provide OPD benefits, 88 percent of participants are providing consultations with doctors, followed by dental benefits at 83 percent and diagnostics (such as X-rays, MRIs or scans) at 80 percent. 

The benefits that are forming the core of the outpatient plan are:

Companies providing OPD benefits also reported providing more holistic benefits, including pharmacy benefits at 77 percent, vision benefits at 60 percent, and physiotheraphy and annual check ups at 43 percent - thereby improving the health of employees leading to drop in claims and reducing the costs of overall employee benefits.

What new benefits are being included under employee wellbeing?

An increasing number of companies reported expanding their wellbeing benefits under primary care, with 80 percent of those providing employee assistance programmes and mental health support and 37 percent offering telemedicine. 

Preventive care such as health risk assessments (32 percent) gym benefits (18 percent), and disease management programme (13 percent) are additional benefits being introduced in employee wellbeing benefits programmes.

" We have witnessed a big shift in the way companies want to offer benefits. As a result, there is an increase in benefits plans curated by insurance companies and technology players. The most preferred way of financing these plans is by the insurer - not in-house. Benefits cost control, minimum member requirements, benefits prevalence and limited provider capability are the major obstacles for companies in implementing outpatient benefits programmes," said Shantanoo Saxena, executive vice president of Health Solutions for India at Aon.

How are these plans financed?

Currently, 74% of outpatient programmes are administered with reimbursements and cashless options given to employees. Cashless only is at 26%.

The coverage under primary care plans is majorly offered as fixed covers at 69% under a family floater with 100% employee coverage. 90% cover spouse and children and 45% cover parents.

What is the sum insured?

The market sum insured ranges between Rs 1000-Rs 1,00,000 for outpatient plans, with 43% of employers opting for an Rs 10,000 OPD cover.

Most covers are in the range of Rs 1000-15,000 as they cover the utilisation for most employees, which is between 2-3 GP visits in a year. The balance sum insured is utilised in dental and vision sub-limits.