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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 or 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 in your pocket when clubbed with other medical costs. Hence, it is recommended to buy a health insurance plan that covers OPD cover under its base policy. Keep reading to know more about the features and benefits of health insurance with OPD cover in India.

Features of Health Insurance with OPD Cover

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 Health Insurance with OPD Cover

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

  • It costs you less compared to in-patient 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 accident-related emergencies

  • It helps you and your loved ones under the family floater plan, in case someone requires frequent OPD visits

  • Enables you to get coverage for OPD visits in case of chronic ailments or pre-existing diseases

Inclusions Under OPD Cover

  • With certain OPD insurance covers, the insured gets access to medical experts and doctors via call or 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.

Exclusions Under OPD Cover

  • 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 for Health Insurance with OPD Cover

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 Buy Health Insurance with OPD Cover on Finserv MARKETS?

Here’s how you can purchase medical insurance with OPD coverage on Finserv MARKETS:

  • Go to the ‘Health Insurance’ section on Finserv MARKETS

  • Select the type of health plan you want to buy

  • Fill out the application form with the required details

  • Choose the health insurance plan with OPD cover

  • Add riders and review the policy terms

  • Pay the premium online

  • Your health insurance policy document will be sent to you, soon!

How to File a Claim Under OPD Cover?

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.


3. Individuals with Group Health Insurance


As you may already know, group health insurance offers limited coverage and cannot be personalised. So, if you are covered under a group health plan and are planning to opt for an individual insurance policy, then medical insurance with OPD cover is for you! Such a plan will help you secure an OPD benefit that isn’t available under every health policy and gain extra coverage beyond the group plan.


4. Senior Citizens


Health insurance plans are 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.

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.


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.

Head over to opt for the best OPD health insurance plans in India at Finserv MARKETS now! Furthermore, you can benefit from features such as cashless claim settlements, reinstatement benefits, 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.

Best Health Insurance Plans Available at Finserv MARKETS

FAQs on Health insurance with OPD Cover

  • ✔️What is the difference between OPD cover and day care treatment?

    Though both of these are quite similar to each other, there are a few differences in certain aspects. Day care treatment requires hospitalisation of less than 24 hours whereas OPD health insurance doesn’t require hospitalisation. Another difference is that OPD cover comes with a sub-limit while day care treatments are covered up to the sum insured amount. 

  • ✔️When can I make use of my medical insurance with OPD coverage?

    You can use your OPD cover health insurance for minor procedures, treatments or surgeries that do not require hospitalisation.

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