What Is OPD?
Out-patient Treatment, commonly referred to as OPD, is a type of medical treatment that does not require you to get hospitalised. OPD treatments cover doctor consultations, diagnostics, and minor treatments that can be completed without hospitalisation. All hospitals have a dedicated out-patient department to take care of patients who do not need hospitalisation.
What is OPD Cover in Health Insurance?
The OPD cover in health insurance refers to the coverage of the expenses related to outpatient treatment. It makes sure that the health insurance provider covers the medical expenses you incur even without hospitalisation.
Most health insurance plans do not provide an OPD cover, and these are usually available as an add-on cover. Some health insurance companies provide OPD insurance cover along with their basic plan.
Similar to other covers available for health plans, OPD cover in health insurance plans are designed to provide you with financial assistance for health-related issues. With medical inflation consistently on the rise, even a simple and brief doctor consultation could leave your pockets significantly lighter.
So, it is important to check if the policy you choose has OPD cover. This cover includes consultation with doctors, dental treatments, diagnostic tests, treatment for fractures, pharmacy expenses and more.
Top Health Insurance Plans with OPD Cover
Policy name |
Benefits |
Premium costs |
Bajaj Allianz Tax Gain |
Minimum and maximum entry age of 18-75 years All OPD expenses covered in a single plan Claim settlement ratio of 98.61% |
Starting at ₹2194 |
Aditya Birla Activ Health Enhanced Platinum Plan |
Maximum coverage from ₹2 Lakhs to ₹2 Crores OPD limit of ₹5000- ₹20,000 Minimum entry age of 5 years in case of an individual plan Claim settlement ratio of 99.36% |
Starting at ₹3887 |
Care Family Health Insurance Plan |
Maximum coverage from ₹3-₹6 Lakhs Minimum entry age of 91 days OPD cover in health insurance from ₹5,000-₹50,000 Claim settlement ratio of 100% |
Starting at ₹5277 |
Disclaimer: The premium costs are subject to change as per the issuer.
How Can You Buy Health Insurance With An OPD Cover?
It is easy to assess, compare, and select a health insurance policy with OPD cover by following the steps mentioned below.
Click on the Check Plans button mentioned on the top of the page.
Enter all the necessary information in the application form
Select a health insurance policy that includes an OPD cover
Add the health insurance add-on covers you wish to include in the policy
Get a quote for the policy
Check the policy terms and the quote for premium
Pay the premium online if you want to proceed
Await email confirmation
This is all you need to do if you want an OPD cover in health insurance.
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What Are The Features And Benefits of OPD cover in health insurance?
Here are the major features of an OPD cover in health insurance.
1. First step of medical treatment
An OPD usually starts off your medical treatment, regardless of its severity. Whether you visit a doctor to get treatment for a common cold or a severe chest ache that could potentially be diagnosed as a cardiovascular ailment, the first instance of consultation with a medical professional is an OPD treatment.
2. Key to early diagnosis
An OPD treatment is instrumental in diagnosing any illness right in its infancy. When you get an OPD cover in health insurance, your doctor consultation charges are covered by the policy, so you can ensure you monitor your health better.
3. Foundation of future medical treatments
An OPD treatment, especially lab tests and radiology, serves as the basis of any future course of action for your medical history and treatment.
4. Access to quality medical care
With an OPD cover in health insurance, you can access the best available medical advice without compromise or delay.
5. Financial support for basic illnesses
The best health insurance with OPD coverage allows you to reduce out-of-pocket expenses for regular medical needs so you can protect your finances while addressing your health.
There are several benefits of health insurance with OPD cover, including:
6. Extensive coverage
An OPD treatment usually comes with a lower cost in comparison with in-patient treatments. However, the cost can still be substantial, especially if you visit the doctor often, which is why having an OPD cover is a must. This way, you can get comprehensive health insurance coverage.
7. Coverage for minor surgeries
An OPD cover in health insurance is important if you have to undergo minor surgeries such as removal of lesions or a surface-level biopsy.
8. Access to specialists
With an OPD cover in health insurance, you can consult doctors specialising in particular fields of medicine (and surgery) and have access to the latest treatment facilities.
9. Accidental injuries
An OPD cover in health insurance also includes the cost of treatments associated with an accident-induced injury.
10. Coverage for frequent OPD visits
If you have a pre-existing disease or any medical condition that requires frequent visits to the hospital but not hospitalisation, then an OPD cover can be of great assistance.
What Are The Inclusions And Exclusions Under OPD Cover in Health Insurance?
Here are the most common inclusions and exclusions under an OPD cover in a health insurance policy.
Serial number |
Inclusions of an OPD Cover in Health Insurance |
Exclusions of an OPD Cover in Health Insurance |
1 |
In some cases, access to telephonic consultations with doctors |
The expenses resulting from the treatment of injuries caused by engaging in any illegal activities |
2 |
In some cases, coverage for OPD consultations referred to you by a doctor |
The cost of medical treatment required due to any kind of substance abuse |
3 |
The cost of visits to the clinic of a doctor |
Coverage for daycare procedures, in-patient treatments, and treatments based on naturopathy |
4 |
Individuals aged between 91 days and 65 years can be covered under an OPD cover in health insurance |
The cost of cosmetic surgery and treatments |
5 |
Diagnostic examinations and laboratory tests |
Expenses of medical treatments caused by self-inflicted injuries |
Why Should I Opt For an OPD Cover in Health Insurance?
It may seem like the most critical aspect of a health insurance policy is related to
hospitalisation expenses and the pre- and post-hospitalisation costs. However, not all medical conditions or treatments require you to be hospitalised. In fact, a majority of medical treatments are categorised as out-patient treatments.
Whether you are visiting the doctor for a regular check-up or getting a cast on your fracture, the expenses can be substantial. This is why you must select a health insurance policy with OPD cover. If you need to get OPD treatments on a regular basis, buying health insurance with OPD cover is highly advisable.
Who Should Buy a Health Insurance Plan With An OPD Cover?
Everyone can benefit from an OPD cover in health insurance policy; however, here are specific individuals who should prioritise this.
Young people
Since health insurance is relatively cost-effective for individuals between the ages of 20 and 45, it is advisable to select a policy with a wide coverage as possible. This includes a cover for out-patient treatments.
Senior Citizens
Ageing entails a distinct set of health-related challenges. This is why senior citizens must choose a health insurance policy that comes with an OPD cover.
What Are The Eligibility Criteria For Health Insurance With OPD Cover?
There is no specific eligibility criteria to buy an OPD cover in health insurance. An OPD cover is a usual part of a standard health insurance policy. So, the eligibility criteria for the policy applies to all the covers contained therein.
As long as you fulfil the eligibility criteria for a particular health insurance policy, which comprises coverage for OPD treatments, you will not be required to meet any additional terms.
How Can You File A Claim Under An OPD Cover in Health Insurance?
You can avail the OPD cover benefits in your health insurance policy by filing a claim. This can either be cashless or a reimbursement claim.
Cashless Claim for an OPD cover in Health Insurance
If you wish to receive out-patient treatment at one of the network hospitals of your health insurance provider, inform your insurer within the specific time as mentioned in the policy and file a cashless health insurance claim.
You can get the form for such a claim at the hospital. By availing a cashless health insurance claim, you will not need to pay any amount for your treatment out of pocket. The bill shall be directly settled between the hospital and your health insurance provider.
Reimbursement Claim for an OPD cover in Health Insurance
If you have received OPD treatment at a non-network hospital, then you can file a reimbursement claim for the expenses. Inform your health insurer within two days from the date of receiving the treatment.
Submit the duly filled reimbursement claim form and the required supporting documents to the insurer. After the verification of your claim form and the supporting documents, the insurer shall settle the claim.
Out-patient treatments are common and carry significant expenses. If you wish to have comprehensive health insurance coverage, getting an OPD cover in health insurance is ideal. If you are looking for the right health insurance plan, browse through top budget-friendly policies on Bajaj Markets. Select an OPD cover in health insurance plan that best suits your requirements.
