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Health insurance with OPD Cover

Some illnesses and diseases do not require hospitalisation for the recovery of the patient. You can avail doctor’s consultation, diagnosis, and treatments without having to stay at the hospital for a prolonged period. In the medical industry, this is known as the Out-Patient Department - OPD.

Let us understand what OPD is and its relevance in a health insurance cover, in detail.

What is OPD?

As stated earlier, some illnesses do not need you (the patient) to be hospitalised for treatment. However, it can involve seeking primary healthcare facilities, doctor’s consultation, or diagnosis, etc. It can also include dental treatments, fractures and other minor surgeries. Such charges are categories under the Out-Patient Department (OPD).

The OPD expenses can be hefty on your pocket when clubbed with other medical costs. Hence, it is recommended to buy a health insurance plan that offers OPD cover under its base policy. Keep reading to know more about the features and benefits of OPD cover in health insurance.

Features of OPD Cover in Health Insurance

Here are a few salient features of health insurance plans with OPD cover.

  • OPD is the first point of contact when seeking any kind of medical treatment
  • It allows you (the patient) to recognise any health issues at an early stage
  • It facilitates the process for further medical care and hospitalisation
  • It ensures that you have access to best-in-class medical experts whenever needed
  • The coverage is ideal for basic illness prevention and vaccinations

Benefits of OPD Cover in Health Insurance

The following are the benefits of having health insurance with OPD cover.

  • It costs you less compared to inpatient hospitalisation
  • The cover comes in handy for minor surgeries
  • It gives you access to a wide range of specialists and medicines
  • It takes care of the accidental related emergencies
  • It helps your concerned doctor under your health history

Health Insurance with OPD Cover - Inclusions & Exclusions

The table below gives an overview of the inclusions and exclusions of OPD cover.

OPD Cover Inclusions

●     With certain OPD covers, the insured gets access to medical experts and doctors via call/chat services.

●     Some covers take care of outpatient consultations recommended by a doctor or specialist in the given policy year.

●     It sometimes covers the cost of clinical visits to the concerned doctor for treatment.

●     It covers the insured and his/her family members (depending on the type of health insurance policy) between the age of 91 days and 65 years.

●     It provides discounts on diagnostics and lab tests.

OPD Cover Exclusions

●     It does not cover the expenses arising due to involvement in illegal activities.

●     It does not cover treatment expenses arising due to intoxicating substance abuse.

●     It does not provide cover for inpatient treatment, daycare procedures and naturopathy treatments.

●     It does not cover cosmetic treatment expenses.

●     It does not cover medical expenses arising due to self-inflicted injuries.

Eligibility Criteria

There are no such eligibility criteria if you want to avail the benefits of OPD cover under your health insurance plan. The basic eligibility depends on the type of health insurance plan you have purchased. So, if your regular health plan provides OPD, then you are free to avail the benefits of the same.

How to File a Claim?

You can raise a claim request on your health insurance plan with OPD cover in two ways -

1.Reimbursement Claim:

Here, you have to inform the insurer about the treatment and other procedures within two days of availing the facility. Once you are done seeking treatment, you have to raise a claim request with the insurer and submit relevant documents for the same. Upon verification and approval, the insurer will settle the claim amount into your bank account.

2.Cashless Claim:

If you are seeking medical guidance or treatment at the nearest network hospital enlisted by your insurer, you can avail cashless claim settlement facility. All you have to do is inform the insurer and submit the cashless claim request form available at the hospital insurance desk. After this, the insurer will settle the claim amount directly with the hospital.

Who Should Buy a Health Insurance Plan with OPD Cover?

Here’s a list of people for whom the health insurance plan with OPD cover seems ideal -

1. Fitness Enthusiasts:

People who are into healthy living and fitness are less likely to fall ill. However, they are still exposed to numerous injuries related to workout wherein the OPD cover may come in handy.

2. People Between Age 25 years and 40 years:

Having a health insurance plan with OPD cover at an early stage in life is cost-effective and saves tax. The OPD cover will help cover the costs of minor surgeries and medical treatments along the way.

3. Senior Citizens:

Health insurance plan is crucial for senior citizens. While making such a wise investment, a little extra will not hurt. Having health insurance with OPD will ensure that dental treatments and minor surgical expenses are covered as well.

Conclusion

As we know, medical costs across the world are rising by the day. Access to basic healthcare services can burn a hole in your pocket. Hence, having a health insurance plan with OPD cover will ensure that a simple visit to the doctor, diagnosis, or minor surgeries do not cost you your savings. Make it a point to check with your insurer whether OPD cover is included in the basic health plan or do you have to purchase it separately.

The health insurance plans at Finserv MARKETS provide OPD coverage under the basic policies. Besides, you can benefit from features such as cashless claim settlements, reinstatement benefit, extensive coverage, tax benefits, and more. Plus, you can use the health insurance calculator to determine the premiums charged on your selected coverage. That way, you can make an informed decision when buying health insurance.

Read more about health insurance benefits by visiting Finserv MARKETS website.

FAQs on OPD Cover

  • ✔️What is the limit on OPD cover?

    Typically, the OPD cover limit is the same as the health insurance coverage. If you raise a claim request towards the OPD expenses, the amount will be deducted from the overall sum insured amount. 

  • ✔️Can I buy OPD cover?

    Yes. OPD cover is usually included in your primary health insurance plan or can be purchased as a standalone add-on cover on some health plans available online.

  • ✔️Are there any tax benefits on OPD cover?

    Yes. When you buy a health insurance plan with OPD cover, you can avail tax benefits under Section 80D of the Income Tax Act, 1961.

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