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 |
1 |
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 |
2 |
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 |
3 |
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. |
4 |
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 |
5 |
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.
Visit the official website of any leading health insurance provider.
Click on "View Health Insurance Plans" or "Get Quote".
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's terms and the quote for premium.
Pay the premium online if you are in agreement with the coverage and the cost of the policy.
Await the arrival of your health insurance policy in your email inbox.
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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