OPD Cover in Health Insurance

In today’s day and age, health insurance is an essential backup needed to manage your healthcare expenses. But every medical need doesn’t require hospitalisation and can be treated by a consultation with the doctor. So, does your health plan come with an OPD cover? A report by Statista showed that 22% of Indians consult with a physician at least three times a year. In case your insurance doesn’t cover this expense, you would have to bear the cost even while having a health policy. So, let’s understand what OPD cover is and how it is beneficial for you.

What Is OPD Cover in Health Insurance?

As many ailments and illnesses do not require hospitalisation, they get treated by consulting a doctor without having to stay back at the hospital. This is termed as OPD or Out-Patient Department that deals with the diagnosis and treatment of ailments. Medical conditions like a dental check-up, an eye test or just plain fever and cough get covered under OPD. Thus, you can visit the clinic and get the medication by paying a consultation fee with a short appointment.

Understanding OPD Coverage

Before diving into OPD coverage, let’s take a quick look at what a health policy is and what it has to offer. Commonly categorised as general insurance, a health policy is a measure that allows you to protect your finances in the face of health emergencies. Since there are various types of health policies available, you can look at your requirements and choose the ones that suit you, to cover yourself as well as your family. If you are worried about the expenses of such policies, you may consider using an online health insurance calculator to get an idea of the premium amount.* The need to seek healthcare in an OPD can arise for anyone. Even minor surgeries may be taken care of in the OPD, after which the patient may be free to go home and recover in the next few hours. However, the cost associated may be significant, and it is always helpful to have some support when it comes to bearing such costs. While health insurance policies are a way to get financial support for these costs, your regular health insurance policy may not offer OPD coverage. Hence, it is ideal to consider a policy that covers OPD treatments, so you may rest easy about any such treatments you may have to seek. OPD coverage encompasses medical expenses incurred outside of hospitalisation, including consultations, diagnostic tests, prescription drugs, and specialised treatments. While traditional health insurance policies primarily focus on inpatient care, OPD coverage extends financial protection for routine medical needs, promoting holistic healthcare management.*

Benefits of OPD Expenses Coverage in Health Insurance

There are several perks of having OPD cover in health insurance in India as most of the times we experience minor health problems. So, allow us to explain the benefits in detail:

1. You can claim OPD expenses incurred during the policy period apart from the cost of hospitalisation
2. For specific minor surgical procedures that don’t need 24 hours stay at the hospital can be covered under OPD cover
3. By purchasing health insurance with OPD cover, you get access to a wide range of clinics as well as hospitals with a consultation room
4. You can file multiple claims within the same policy year up to the capped limit set by your insurer
5. Depending on your insurance provider, you can also claim pharmacy bills and cost of medicines under the health insurance with OPD cover
6. As most health plans require 24 hours of hospitalisation for claiming the expenses, under OPD cover in health insurance, there are no such requirements to be fulfilled

List of OPD Cover Benefits That You Can Enjoy

Here is a list of medical expenses included under the OPD benefit:

1. Diagnostic fees
2. Minor surgical procedures
3. Medicine bills
4. Dental procedures and treatment
5. Consultation fees
6. Cost of hearing aids, crutches, lenses, dentures, eyewear, etc.
7. Ambulance cover
8. Additional covers may also be available for extra coverage depending on your insurer

Advantages of OPD Cover

Here are a few advantages of having an OPD health cover.

1. Less Out-Of-Pocket Expenses

OPD coverage mitigates the financial burden of routine medical expenses, ensuring individuals can access timely healthcare without significant financial strain.

2. Comprehensive Coverage

It offers inclusive coverage for various outpatient services, including dental care, eye examinations, and preventive screenings, enhancing overall healthcare accessibility.

3. Tax Benefits

Premiums paid towards OPD coverage qualify for tax deductions under Section 80D of the Income Tax Act, reducing taxable income and offering additional savings opportunities.

4. More Convenient Healthcare Access

OPD coverage eliminates cost concerns associated with outpatient treatments, encouraging individuals to seek prompt medical attention and prioritise preventive care.

Disadvantages of OPD Cover

It is also important to consider the cons of this sort of coverage.

1. Higher Premiums

OPD coverage may entail higher premiums compared to standard health insurance policies due to its extensive coverage of outpatient expenses.

2. Limited Coverage and Availability

Certain exclusions may apply to OPD coverage, such as cosmetic treatments, alternative therapies, and treatments conducted outside of India. Additionally, not all insurance providers offer OPD coverage, limiting accessibility for some individuals.

Who Should opt for Health Insurance OPD Cover?

Though OPD cover is suitable for most individuals to secure all healthcare needs, allow us to explain who should purchase this cover:

1. Individuals Between the Age of 25 to 40 years

Hardly ever major surgeries or injuries affect us, but with age, the onset of such ailments begin, which is why people opt for health plans early in life. It helps with the waiting period of many diseases, and the premiums are cheaper as well. But we do suffer from frequent cold and require dental care, making OPD cover a lucrative plan. You can save up on such minor expenses that you incur several times a year and be worry-free about finances.

2. Individuals Who Are Older Than 60 years

With old age comes illnesses and chances of getting sustaining injuries due to brittle bones. Regular visits to the doctor for minor conditions can easily take a toll on your savings. You can purchase a health plan with an OPD cover which can offer extensive coverage for all types of medical treatment. Thus, you can rest assured that your retirement fund will not be utilised for any healthcare expenses. Health insurance with OPD cover plays an important role warding off any healthcare expense that may come your way! So, get suitable insurance that can offer maximum coverage.

Comparison with Traditional Health Insurance

Traditional health insurance policies primarily focus on hospitalisation, surgery, and medical procedures, leaving gaps in coverage for outpatient treatments and consultations. By incorporating an OPD rider or standalone OPD insurance policy, individuals can bridge these gaps and ensure comprehensive coverage for their healthcare needs. OPD coverage plays a pivotal role in modern healthcare planning, offering financial protection and accessibility for outpatient treatments and consultations. With the flexibility to customise coverage based on individual healthcare requirements, OPD coverage enhances healthcare affordability and promotes proactive healthcare management. Furthermore, the tax benefits associated with OPD coverage provide additional incentives for individuals to prioritise comprehensive health insurance planning. By leveraging tax deductions under Section 80D, individuals can optimise their healthcare investments while safeguarding their financial well-being. OPD coverage represents a prudent investment in healthcare security and financial stability. By carefully evaluating coverage options, individuals can make informed decisions to enhance their healthcare accessibility and mitigate the financial risks associated with medical expenses. As healthcare needs evolve, OPD coverage continues to serve as a cornerstone of comprehensive health insurance planning, ensuring peace of mind and holistic healthcare management for individuals and families alike. You may consult your insurance agent or insurance provider to understand the forms of OPD coverage you can choose from. Furthermore, you may also start by browsing plans online so you may compare them and get premium quotes. *Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.