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 of the covered person incurred even without hospitalization. Most health insurances do not provide an OPD cover, and are usually available only as an add-on cover. 

Some companies of health insurance provide OPD insurance cover along with their basic plan. Check out the details of the OPD health insurance plans with their features and coverage benefits.

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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.

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Frequently Asked Questions On OPD cover in Health Insurance

  • ✔️What is an OPD cover in health insurance?

    An OPD cover or out-patient cover is a health insurance benefit that covers the cost of medical treatments and minor surgeries that do not require the patient to be hospitalised. 

  • ✔️Is an OPD cover the same as the cover for a Daycare Procedure?

    No, the cover for OPD treatments is not the same as that for daycare procedures. OPD treatments are the medical treatments for which hospitalisation is not required at all. On the other hand, daycare procedures require you to be hospitalised, at least for less than 24 hours.

    Another significant point of difference between both covers is that an OPD cover in health insurance usually carries a sub limit whereas the cover for daycare procedures is defined by the sum insured available in your health insurance policy.

  • ✔️What does an OPD cover in health insurance include?

    An OPD cover in a health insurance policy provides you coverage for the cost of doctor consultations and minor surgeries, to name a few.

  • ✔️Is an OPD cover available with most health insurance policies?

    Yes, a majority of health insurance plans comprise a cover for out-patient treatments. However, you must check the inclusions and exclusions of a particular health insurance policy to have clarity. 

    Although it is advisable to purchase a health insurance policy with an OPD cover, you can also it as an add-on health insurance rider.

  • ✔️Can I avail cashless insurance for OPD treatments?

    Yes, you can make a cashless claim for out-patient treatments.

  • ✔️What is the limit for OPD cover in health insurance?

    The limit varies from one insurance provider to the other. Check the policy terms and conditions to understand the limit. Since OPD is a part of the total coverage, any claim you file will be deducted from your total sum insured.

  • ✔️Can I purchase OPD cover online?

    Yes, you can buy an OPD cover in health insurance online. Many insurers provide the cover as an add-on or as a part of their basic plan. Choose the best healthcare provider according to your requirements. You may also check some of the top health insurance covers on Bajaj Markets.