More health insurance companies would start offering insurance cover on the OPD (outpatient department) expenses, said Kiran Gopal Vaska, joint secretary & mission director (ABDM) at National Health Authority (NHA). He said that health insurers typically don’t cover OPD expenses in their policies due to the high processing costs.
“Today, one claim processing costs around Rs 600-700. It would be in the same range for the OPD claims. If the processing itself costs Rs 700, insurers seldom provide OPD cover. With the national health claims exchange (NHCX) where the systems have been automated, the processing cost can come down to as low as Rs 50. As the cost goes down, the insurers can start giving OPD cover,” Vaska told FE.
Speaking at the CII’s annual health summit 2024, Vaska said that the NHCE has been live for over a year. “We have onboarded 400 hospitals and nearly all health insurance companies are on the exchange. We are running Pradhan Mantri Jan Arogya Yojana (PM-JAY) on it. Till recently, we were handling retail policies but now group insurance policies are also being processed,” he said.
In India, about 80% of the health insurance policies are group insurance. With the addition of group insurance claim processing, the NHA is expecting the volumes to go up. “We have processed nearly 9 million claims so far. We are taking a graded approach to roll out this exchange. We will be adding more states going forward,” he said.
NHCX is developed under the Ayushman Bharat Digital Mission (ABDM) in consultation with the Insurance Regulatory and Development Authority of India (IRDAI). The aim of the single-window digital platform is to facilitate faster claim processing for policyholders and reduction in costs for insurance companies. It brings all stakeholders involved in the claim process such as insurers/third-party administrators and service providers at one place for faster approval of claims.
