INSIGHTS

How a large information technology company expanded outpatient coverage
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Situation:

A large information technology company with more than 5,000 employees had an objective of providing a holistic care program to its employees. A pioneer in the health and benefits program, the company’s objective was also to become an employer of choice for prospective job applicants.

Challenge:

  • The company’s benefit program did not provide for primary care. In India, healthcare delivery depends primarily on secondary and tertiary care, which makes it costly. Primary care is important for arresting diseases in the first stage and also for preventing lifestyle and other diseases.
  • There was also strong employee feedback about rising outpatient costs. Medical costs relating to doctor consultation fees, diagnostics tests, prescribed health check-ups, and vaccinations are high and are increasing over the years.

Action :

Outpatient department (OPD) refers to the primary healthcare services, such as doctor visits, diagnostics, and other investigative examination, pharmacy spend, and certain treatments that do not require hospitalisation or in-patient care.

The Marsh India EH&B team helped the company with an insurance coverage for its employees that included out-patient expenses. The team worked extensively with the insurance company to achieve this. The result was an insurance product with the following attributes:

  • Upper limits for each component for discipline and claims control.
  • Flexibility to choose OPD limit as per individual requirements.

More than 70 % of the claims are made for diseases related to lifestyle disorders, having an OPD cover along with other preventive measures might control the progression of disease and prevent the hospitalization in about 44.3% of cases*. (Source : FICCI Study on OPD and Preventive Care Dec 2015)

Impact:

All the employees appreciated the program. The inclusion of health check-up and second opinion costs was especially appreciated by the employees. The OPD coverage is an invaluable tool to assess health risk and early detection of a chronic or life threatening disease. The company has experienced lower absenteeism and enjoyed the resultant cost savings. This is an indirect, but important way to lower overall costs.

Suresh Babu
Senior Vice President
EH&B practice

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