HR leaders rely on their insurance broker for more than placing a group health policy. They want to know what peers offer, what is changing, and what to add next. Outpatient (OPD) cover is fast becoming one of those conversations. Only about 1 in 4 Indian companies offers an OPD wallet today, according to ekincare's India Inc. Health Benefits Benchmark 2026, which leaves room for brokers to bring clients a clear, data-backed recommendation. This guide sets out the ways to add OPD to a client's programme, how to size it, and how to make it work through the policy year.

The short answer

  • OPD can sit inside the group policy or alongside it. Insurers can add OPD as a rider or add-on, and many companies also use a separate OPD wallet from a health benefits provider. Both are valid; the right choice depends on the client.
  • Use benchmarks to size it. Among companies that offer OPD, the typical wallet is ₹8,000 to ₹15,000 per employee per year, about 4 in 5 programmes include cashless access, and 7 in 10 cover family members.
  • Connect it to what the client already buys. Three in four companies run annual health check-ups, but only one in four funds the care that follows. OPD closes that gap.
  • Plan the follow-through, not just the placement. Employee communication, follow-up after check-ups and clear usage reporting are what make OPD visible at renewal.

Why OPD belongs in the renewal conversation

Group health insurance protects employees when they are admitted to hospital. Most of an employee's health needs in a year never reach a hospital: a doctor's visit, a blood test, a prescription, a counselling session. OPD covers that everyday care, and it is the part of the benefit employees notice most often.

Three points make OPD a timely topic to raise with clients:

  • Clients are already paying to find health problems. Three in four companies offer an annual health check-up. ekincare's research shows more than 1 in 3 people tested have abnormal vitamin, weight or cholesterol markers. Without OPD, the follow-up consultation and tests fall on the employee, and many skip them.
  • Labour code rules are raising the stakes for check-ups. Draft state rules, including Karnataka's and Maharashtra's, would require factories to provide a free annual check-up for workers aged 40 and above. Manufacturing clients will need a plan for what happens after the result.
  • Mental healthcare is mostly outpatient. Therapy, psychiatrist consultations and long-term medicines happen outside hospital. Clients investing in counselling often need an outpatient route for the cases that need clinical care.

For a broker, OPD is a way to add visible value to the programme at renewal, with a recommendation the client's HR team can take to finance.

The ways to add OPD to a client's programme

Indian insurance law already treats outpatient care as part of health insurance: the Insurance Act, 1938 defines health insurance business to include in-patient and out-patient benefits. IRDAI's Master Circular on health insurance of 29 May 2024 also requires insurers to make products, add-ons or riders available for every situation of treatment, including outpatient treatment. That gives brokers more than one route.

Option 1: an OPD add-on or rider within the group policy

The insurer extends the group policy to cover outpatient expenses up to a set limit.

Works well when:

  • The client wants one policy, one insurer and one renewal
  • Employees are concentrated in cities where the insurer's outpatient network is strong
  • The client is comfortable with OPD claims forming part of the policy's claims experience, which insurers consider in renewal pricing

Option 2: a separate OPD wallet from a health benefits provider

The group policy continues to cover hospitalisation, and a benefits provider runs an employer-funded OPD wallet alongside it.

Works well when:

  • The client wants a fixed, predictable OPD budget per employee
  • Employees are spread across many cities, plants or remote locations
  • The client wants check-ups, consultations, diagnostics, pharmacy and mental health in one employee app, with usage reporting

Option 3: both, each doing what it does best

Some clients keep hospitalisation and selected outpatient benefits within the policy, and use a wallet for everyday care such as consultations, medicines and follow-up after check-ups. The broker designs the split so nothing is covered twice and nothing falls through the gap.

There is no single right answer. The broker's knowledge of the client's workforce, budget and insurer relationships is what makes the recommendation fit.

How to size OPD for a client

Benchmarks from ekincare's India Inc. Health Benefits Benchmark 2026 give a starting point:

  • Wallet amount: among companies that offer OPD, the typical amount is ₹8,000 to ₹15,000 per employee per year, with a median of ₹10,000. Companies with 2,000 to 9,999 employees set a median of ₹15,000.
  • Cashless access: about 4 in 5 OPD programmes include cashless access at network providers. Fewer than 1 in 5 are reimbursement-only.
  • Family cover: 7 in 10 OPD programmes extend to family members.
  • Sector norms: nearly half of IT and ITeS companies offer an OPD wallet, almost twice the overall rate, while healthcare and manufacturing companies offer it far less often.

Then adjust for the client: where employees live, the age mix of the workforce, whether parents are covered elsewhere, and what the client already spends on check-ups.

Making OPD work after placement

An OPD benefit that employees don't use is hard to defend at the next renewal. Three steps help:

  1. Launch it properly. Employees need to know what the wallet covers, where it works and how to pay at a clinic. A short launch plan with the client's HR team makes a large difference to first-year usage.
  2. Link it to check-ups. When an employee gets an abnormal result, the follow-up consultation and tests should be cashless from the same wallet. This is where OPD shows its value most clearly.
  3. Report on it. Ask the provider for anonymised quarterly reporting on usage by benefit and location, follow-up after check-ups and top reasons for consultations. It gives the broker evidence to take into the renewal conversation.

Before recommending any provider, run them through the same ten questions every client should ask: network near employees, cashless at the point of care, what the wallet covers, reimbursement speed, family cover, follow-up after check-ups, mental health, reporting, data protection and pricing.

How ekincare works with brokers

ekincare works with brokers and insurers as a partner. We support the broker's recommendation with benefits benchmarks, network coverage for the client's locations, check-ups and cashless OPD across 90,000+ providers in 500+ cities, and anonymised reporting the broker can use with the client through the year. Partner with us on your next client renewal.

Frequently asked questions

Can OPD be added to a group health insurance policy in India? Yes. The Insurance Act, 1938 includes out-patient benefits within health insurance business, and IRDAI's Master Circular of 29 May 2024 requires insurers to make products, add-ons or riders available for outpatient treatment. Availability and terms vary by insurer.

What is the difference between an OPD add-on and an OPD wallet? An OPD add-on extends the group policy to cover outpatient expenses, with claims handled by the insurer. An OPD wallet is a separate, employer-funded allowance run by a health benefits provider alongside the policy. Many clients use one or the other; some use both.

How much OPD cover should a broker recommend per employee? Among companies that offer OPD, the typical amount is ₹8,000 to ₹15,000 per employee per year, with a median of ₹10,000, according to ekincare's 2026 benefits benchmark. Adjust for the client's size, locations and workforce.

Should OPD cover employees' families? Most programmes do: 7 in 10 OPD programmes extend to family members. Parents or in-laws are covered far less often, by about 1 in 8 companies, which makes them a useful option to discuss with clients.

Can mental health care be included in OPD? Yes, depending on the plan. Counselling, psychiatrist consultations and prescribed medicines are outpatient costs and can be covered through an OPD benefit.

Sources

This article is general information, not legal or insurance advice.

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Jehi Jha
22 Oct 2026 7 min read
Marketing Manager