Only about 1 in 4 Indian companies offers an OPD wallet today, according to ekincare's India Inc. Health Benefits Benchmark 2026. For the companies adding one, the choice of provider decides whether employees actually use it. Every provider will show you a large network number and a smooth app demo. These ten questions get past the pitch to what your employees will experience: whether care is truly cashless where they live, what the wallet covers, and whether a check-up result turns into treatment.
The short answer
Ask every provider these ten questions, and score their answers side by side:
- How many providers do you have where my employees actually live?
- Is it cashless at the point of care, or pay-and-claim?
- What exactly does the OPD wallet cover?
- How fast are reimbursements settled when an employee goes outside the network?
- Does it cover family members, and can it cover parents?
- What happens after an abnormal check-up result?
- Is mental health care part of the same benefit?
- What reporting will HR get?
- How is employee health data protected?
- How is it priced, and what happens to unused balance?
1. How many providers do you have where my employees actually live?
A national network total tells you little. What matters is how many doctors, labs and pharmacies an employee can reach near home or work.
Ask for: a count of network providers by PIN code or city for your own employee locations, split into doctors, diagnostics and pharmacies. Include your plants, branches and remote staff, not just head office.
Red flag: a provider that can only quote one national number. Plant workers and remote staff are the groups most often left out of OPD programmes, so check their locations first.
2. Is it cashless at the point of care, or pay-and-claim?
Cashless means the employee pays nothing at the clinic, lab or pharmacy; the amount comes straight from their OPD wallet. Pay-and-claim means they pay first and wait for a refund, which is where usage drops.
Ask for: how an employee pays at a network provider (app, QR scan or card), and what share of the provider's OPD transactions are cashless rather than reimbursed.
Benchmark: about 4 in 5 OPD programmes now include cashless access at network providers. Fewer than 1 in 5 are reimbursement-only.
3. What exactly does the OPD wallet cover?
Two plans with the same wallet amount can cover very different things.
Ask for: a written list of what the wallet pays for: doctor consultations (online and in-person), diagnostics, medicines, dental, vision and mental health. Then ask for every sub-limit, co-pay and exclusion.
Red flag: generous headline cover with small sub-limits on the services employees use most, such as medicines or diagnostics.
4. How fast are reimbursements settled outside the network?
Even with a strong network, some employees will see a doctor who isn't on it. Slow or rejected reimbursements are what employees remember.
Ask for: the average number of days to settle a reimbursement, the share of claims rejected and the top reasons, and how employees submit bills.
5. Does it cover family members, and can it cover parents?
For many employees, the person who needs a doctor this month is a child, a spouse or a parent.
Ask for: whether the wallet can be shared with family, whether parents or in-laws can be added, and how that changes the price.
Benchmark: 7 in 10 OPD programmes extend to family members. Only about 1 in 8 companies extends check-up or OPD cover to parents or in-laws, which makes parents cover one of the clearest ways to stand out from peers.
6. What happens after an abnormal check-up result?
This is the question most buyers skip, and the one that decides whether your health spend works. Three in four companies offer an annual health check-up, but only about one in four funds the OPD care that follows. ekincare's research shows more than 1 in 3 people tested have abnormal vitamin, weight or cholesterol markers.
Ask for: how an employee with an abnormal result is guided to a doctor, whether that follow-up consultation and any tests are cashless from the same wallet, and whether the provider can report how many flagged employees actually saw a doctor.
Red flag: check-ups and OPD run by different vendors that don't share data. The result arrives, and nothing happens next.
7. Is mental health care part of the same benefit?
Most mental healthcare happens outside hospital: therapy, psychiatrist consultations and long-term medicines. Group health insurance mainly pays for hospitalisation, so the outpatient part needs a home.
Ask for: whether counselling, psychiatrist consultations and prescribed medicines can be paid from the OPD wallet, and how a counsellor's referral turns into a cashless appointment.
8. What reporting will HR get?
You can't manage a benefit you can't see.
Ask for: a sample HR report showing usage by benefit, location and age band, top reasons for consultations, follow-up after check-ups, and how often employees book but don't attend. All of it should be aggregated and anonymised; HR should never see an individual's records.
9. How is employee health data protected?
OPD data includes diagnoses, prescriptions and test results, among the most sensitive personal data a company holds. The Digital Personal Data Protection Act, 2023 brings its core obligations, including consent, security safeguards and retention limits, into force on 13 May 2027.
Ask for: the provider's security certifications (such as ISO 27001 and SOC 2), how employee consent is collected, where data is stored, who can access it, and how it is deleted when the contract ends.
10. How is it priced, and what happens to unused balance?
Ask for: whether you pay a fixed amount per employee, per use, or both; what happens to unused wallet balance at year end; and how renewal pricing is set.
Benchmark: among companies that offer OPD, the typical wallet is ₹8,000 to ₹15,000 per employee per year, with a median of ₹10,000. Use your own size band, not the overall average, when you set your amount.
A scorecard to compare providers side by side
Score each provider 0, 1 or 2 on every question. A 2 means the answer is specific, written down and backed by data. A 0 means a vague answer or none at all. A provider scoring 16 or more out of 20 is worth shortlisting.
- Network where you are: 2 = provider counts by your own locations, including plants and remote staff
- Cashless at the point of care: 2 = app, QR or card payment at network providers, with a high share of cashless transactions
- What the wallet covers: 2 = a written list with every sub-limit, co-pay and exclusion
- Reimbursement speed: 2 = average settlement days and rejection rate, in writing
- Family and parents: 2 = family cover included, parents available as an option
- After an abnormal check-up: 2 = guided, cashless follow-up from the same wallet, with a follow-up rate reported to HR
- Mental health: 2 = counselling, psychiatrist consultations and medicines payable from the wallet
- HR reporting: 2 = a sample anonymised report with usage, follow-up and no-show data
- Data protection: 2 = named certifications, a consent process and a deletion policy
- Pricing and unused balance: 2 = clear per-employee pricing, a stated rule for unused balance, and renewal terms
Where ekincare fits
ekincare runs cashless OPD across 90,000+ providers in 500+ cities, with health check-ups, consultations, diagnostics, pharmacy and mental health in one wallet, and anonymised HR reporting. It is certified to ISO 27001 and SOC 2. Score us against the same ten questions as everyone else: talk to us about a benefits review.
Frequently asked questions
What is a cashless OPD provider? A company that lets employees use an employer-funded OPD benefit at network doctors, labs and pharmacies without paying upfront. The cost is settled directly from the employee's OPD wallet.
How do I choose the best cashless OPD provider for my company? Compare providers on the network near your employees' locations, how cashless works at the point of care, what the wallet covers, reimbursement speed, family cover, follow-up after check-ups, mental health, HR reporting, data protection and pricing. Score each one side by side rather than relying on a demo.
What is the difference between cashless and reimbursement OPD? With cashless OPD, the employee pays nothing at a network provider. With reimbursement, the employee pays first and submits bills for a refund. About 4 in 5 OPD programmes now include cashless access, and fewer than 1 in 5 are reimbursement-only.
How much OPD wallet should a company give 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.
Should the OPD provider also run our health check-ups? It helps. When the same provider runs both, an abnormal check-up result can lead straight to a cashless doctor consultation, and HR can see whether employees followed up.
Is OPD covered by group health insurance? Group health insurance mainly covers hospitalisation. Some insurers offer OPD as an add-on, and many companies instead use a separate OPD wallet from a health benefits provider. Compare both against the same ten questions.
Sources
- ekincare, India Inc. Health Benefits Benchmark 2026: benefits configured on ekincare's platform as of September 2026.
- ekincare, India's Silent Health Crisis: a 2023 to 2025 national risk assessment.
- ELP: DPDP Rules published
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