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 Cover In Health Insurance?

Akin to most of the covers available under your health insurance policy, OPD insurance plans are designed to provide you with financial assistance in the wake of health-related issues. With medical inflation consistently on the rise, even a simple and brief doctor's consultation could leave your pockets significantly lighter.


Therefore, it is important to check whether the health insurance policy you opt is the kind that has medical insurance with OPD cover. As mentioned earlier, this cover includes doctor's consultation, dental treatments (available in some policies), diagnosis, fractures, etc.

Why Should I Opt For Health Insurance With OPD Cover?

Although it may seem like the major aspect of a health insurance policy is hospitalisation expenses and the expenses preceding and succeeding it, not only medical conditions or treatments require you to be hospitalised. In fact, a majority of medical treatments can be categorised under 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, which is one of the major reasons why you must select a health insurance policy with OPD cover. If you need to get OPD treatments on a regular basis, then buying health insurance with OPD cover is highly advisable.

What Are The Features And Benefits of Health Insurance With OPD Cover?

Here are the major features of an OPD cover-

        1.First step of medical treatment

An OPD treatment is usually the first step of any 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 to the early diagnosis of any ailment.

        3.Foundation of future medical treatments

An OPD treatment serves as the foundation of any future course of action for your medical treatment, including diagnostic tests.

        4.Access to quality medical care

With an OPD cover in health insurance, you can access the best available medical advice without worrying about its cost.

        5.Financial support for basic illnesses

The best health insurance with OPD coverage is pivotal for you to have financial assistance for basic health-related issues.


There are several benefits of health insurance with OPD cover, including:

        1.Extensive health insurance coverage

An OPD treatment usually has a lower cost in comparison with in-patient treatments. However, the cost can still be substantial, which is why having an OPD cover is a must. This way, you can get comprehensive health insurance coverage.

        2.Coverage for minor surgeries

An OPD cover in health insurance is important if you have to undergo any minor surgeries.

        3.Access to specialists

With an OPD cover, you can consult specialists in particular fields of medicine (and surgery) and have access to the best treatment facilities.

        4.Accidental injuries

An OPD cover also includes the cost of treatments associated with an accident-induced injury.

        5.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 for you.

What Are The Inclusions And Exclusions Under OPD Cover?

The following table provides a succinct summary of the inclusions and exclusions under an out-patient cover in a health insurance policy.

Serial number

Inclusions in an OPD Cover

Exclusions in an OPD Cover


Some OPD covers provide policyholders with access to telephonic consultations with doctors.

The expenses resulting from the treatment of injuries caused by engagement in any illegal activities



With some OPD covers, you can get coverage for OPD consultations referred by a doctor.

The cost of medical treatment required due to any kind of substance abuse



The cost of visits to the clinic of a doctor are also covered under some plans.

Coverage for Daycare Procedures, In-patient Treatments, and treatments based on naturopathy.


Individuals in the age group of 91 days to 65 years can be covered under an OPD cover.

The cost of cosmetic surgery and treatments


With an OPD cover, you can get to save on diagnostic examinations and laboratory tests.


The expenses of medical treatments necessitated by self-inflicted injuries

If you are wondering whether you are eligible to buy an OPD cover with your health insurance policy, then you must know that there is no specific eligibility criteria for it. An OPD cover means a usual part of a standard health insurance policy, the eligibility criteria for the policy apply to all the covers contained therein.


Therefore, as long as you fulfill the eligibility criteria for a particular health insurance policy, which comprises coverage for OPD treatments, you shall not be required to meet any additional eligibility criteria.

How Can You File A Claim Under An OPD Cover?

You can avail the OPD insurance plan benefits under your health insurance policy by filing a claim. This claim can either be a cashless claim or a reimbursement claim.

        1.Cashless Claim

If you wish to receive out-patient treatment at one of the network hospitals of your health insurance provider, then you must inform your insurer as per the timelines mentioned in the policy, and file a cashless 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. The bill shall be directly settled between the hospital and your health insurance provider.

        2.Reimbursement Claim

If you have received OPD treatment at a non-network hospital, then you can file a reimbursement claim for the expenses. You must inform your health insurer no later than two days from the date of receiving the treatment. Then you must 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 in your favour.

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.


  1. Visit the official website of any leading health insurance provider.

  2. Click on "View Health Insurance Plans" or "Get Quote".

  3. Enter all the necessary information in the application form.

  4. Select a health insurance policy that includes an OPD cover.

  5. Add the health insurance add-on covers you wish to include in the policy.

  6. Get a quote for the policy.

  7. Check the policy's terms and the quote for premium.

  8. Pay the premium online if you are in agreement with the coverage and the cost of the policy.

  9. Await the arrival of your health insurance policy in your email inbox.

  10. That's it. You will have health insurance with an OPD cover.

Who Should Buy a Health Insurance Plan With An OPD Cover?

It is advisable for everyone to opt for a health insurance policy with OPD cover. However, the following categories of individuals must invest in such a policy.

        1.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 as wide a coverage as possible. This includes a cover for out-patient treatments.

        2.Senior Citizens

Ageing entails a distinct set of health-related challenges. This is why senior citizens must choose a health insurance policy which comprises an OPD cover.

To Sum It Up

Out-patient treatments are common and carry significant expenses. If you wish to have comprehensive health insurance coverage, then you must opt for health insurance with OPD cover.

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Frequently Asked Questions On Health Insurance With OPD Cover

  • ✔️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 one to be hospitalised, albeit for less than 24 hours.


    Another significant point of difference between the aforementioned covers is that an OPD cover usually carries a sub limit whereas the cover for Daycare Procedures is defined by the sum insured available under your health insurance policy. 

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

    An OPD cover in a health insurance policy provides you coverage for the cost of doctor's 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 on whether it covers OPD treatments. Although it is advisable to purchase a health insurance policy with an OPD cover, you can also select said cover as an add-on health insurance rider

  • ✔️Can I avail cashless insurance for OPD treatments?

    Yes, you can avail of cashless insurance for out-patient treatments. 

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