health insurance with OPD

Health Insurance with OPD Cover Benefits Online in India

Did you know 60% to 80% of our healthcare spending is towards pharmacy bills, medicines, and regular healthcare, not towards hospitalization? Surprised? It is true and backed by research.

Think about it, how many times do you or your family members get hospitalized in a year? Most probably, not a single time. On the contrary, how many times do you incur pharmacy expenditure in a year? Probably a couple of times? Some of you may even be incurring medicine expenses every month – think regular medicines for parents and grandparents or medicines for seasonal flu. All these expenses are paid from your pocket.

What if your out-of-pocket healthcare expenses could be taken care of with the help of insurance? It’s possible with the help of health insurance plans with OPD coverage. Knowing what is OPD in health insurance is very important to steer clear off exorbitant outpatient expenses and ensuring a robust financial protection. Let’s understand all about this knight in shining armor in the form of OPD coverage health insurance.

What is OPD Cover?

OPD Cover is Out Patient Department Cover, which means coverage for expenses such as doctor’s consultation fees, pharmacy bills, dental treatments, and health check-ups, and diagnostics tests. Insurance plans that offer coverage for OPD expenses compensate for the above-mentioned expenses are known as OPD coverage health insurance policies.

These expenses are generally not covered by regular health insurance plans. Even though these expenses may seem small compared to hospitalization, over time, they can add up to huge amounts. Health insurance with OPD assures extra protection; however, insurers may have sub-limits to the sum insured towards OPD expenses. An OPD insurance protects you from seemingly small, yet exorbitant, OPD expenses.

The need for a comprehensive health insurance with OPD coverage stems from the evolving sedentary lifestyle that brings along many chronic illnesses. This adds up to be a significant amount of your overall expenditure on medical treatment. An OPD insurance plan ensures that the daily medical expenses are covered without any financial burdens. The lack of organized healthcare records at a national level also necessitates an OPD coverage. It allows policyholders to avail the best outpatient treatment without getting subjected to any hassles because of operational flaws.

Benefits of Health Insurance with OPD Coverage

Now that we know what is OPD in health insurance, let us know about some of the benefits of a comprehensive OPD coverage health insurance. Here are some of the OPD benefits that are increasingly customers across the country to avail for OPD insurance plans.

  • More coverage: it provides coverage against outpatient expenses, which are not covered by all insurance plans. The additional coverage provided by OPD insurance helps you avoid the seemingly small, but huge OPD costs in the long-term.
  • More tax benefits: compared to plans that do not offer OPD coverage, these plans provide more tax benefits by claiming tax exemption on the premium paid, as well as there is no tax deductible at source for claims.
  • Multiple claims: policyholders can claim reimbursements multiple times, as and when the expenses occur.
  • Pharmacy bills reimbursement: a health insurance plan with OPD coverage provides reimbursement towards pharmacy bills, too, which makes it more beneficial for people who incur regular pharmacy expenses.
  • Wide range of expenses covered: OPD coverage policies cover expenses of various medical bills, including those for crutches, hearing aid, contact lenses, spectacles, dentures, and more, which are not covered in regular health insurance policies.
  • Carry forward feature: some insurance companies allow a fixed percentage of the sum insured to be carried forward in case the cover is not utilized in the policy period.
  • Sum insured: under OPD coverage insurance plans, the sum insured is determined based on the age of the insured. In the case of a family floater, the age of the eldest member is taken into consideration.
  • Cashless facility: some insurance companies offer OPD coverage under a cashless scheme with additional premium.

These are some of the OPD benefits that are increasingly capturing the Indian customers’ attention and compelling them to opt for OPD insurance plans.

Doctor’s fees, professional feesSpectacles, contact lenses (some plans)
Diagnosis tests, x-rays Physiotherapy
Routine check-up, vaccinationCosmetic treatment expenses
Hearing aidVitamins and supplements
Crutches, wheelchairDietician fees, consultation
Dental treatmentBP monitors, thermometers
Minor surgeries, dressing
Spectacles, contact lenses (some plans)

Key Inclusions under OPD Coverage

The health insurance plans that offer OPD coverage include the following outpatient expenses:

  • Doctor Consultation fees
  • Diagnosis tests, X-rays
  • Crutches, Wheelchair, and other similar medical aids
  • Routine medical check-ups, vaccinations, etc.
  • Hearing aids
  • Minor surgeries, wound & fracture dressings
  • Dental treatments
  • Some OPD insurance plans also include spectacles, contact lenses

Key Exclusions under OPD Coverage

The insurance provider will not be liable to pay under following conditions for OPD coverage:

  • Physiotherapy
  • Cosmetic treatments
  • BP monitors, thermometers
  • Vitamins and supplements
  • Dietician fees, consultations

Who should buy health insurance with OPD coverage?

OPD expenses is a significant amount of a person’s medical expenditure. Hence, choosing a health insurance with OPD coverage is the essential first layer of the financial protection that everyone should opt for. Health insurance plans with OPD coverage are beneficial to those who incur regular medical expenses. But, don’t we all?

Health insurance with OPD is a blessing for people who incur regular pharmacy and other healthcare related expenses. The OPD benefits offered by health insurance plans are especially advantageous for people with chronic illnesses such as sinusitis, arthritis, and diabetes, among others, who regularly need to visit a doctor. People who have low immunity and are more prone to catching fevers may also benefit from OPD coverage insurance. OPD coverage is also essential for senior citizens who can invest in health insurance that cover their OPD expenses, including diagnosing ailments, medical check-ups, or any minor surgical procedures.

The premium for OPD coverage can be a bit higher than the regular plans, hence one should always figure out whether it will be beneficial to buy or not. This can be done by knowing the average healthcare expenses and the estimate of premiums.

Here’s a table that gives a picture of the difference between premiums of health insurance plans with OPD coverage and regular plans of different companies and different age groups.

health insurance with opd

Source: Economictimes

Considering the benefits of OPD coverage, it can be a savior for those who incur regular healthcare expenses that are not covered by regular insurance plans. In India, OPD cover is a fairly new feature offered by a few insurance companies. Let’s look at some insurers and the plans offered.

Here are a few selected health insurance plans with OPD coverage:

Max Bupa Heartbeat Platinum PlanA plan designed for individuals or family, the minimum sum insured under this plan is Rs 15 lakh and maximum OPD coverage provided is Rs 30000.
Maternity expenses incurred before and after childbirth - vaccinations, childcare cover, and more

No entry age conditions

In the case of non-utilization of cover, 80% is carried forward

In case of a family floater, the age of the eldest member is considered to determine the premium

The policyholder can avail tax benefits under Section 80D
HDFC Ergo MaximaA comprehensive health insurance plan, Maxima is designed to cater to all kinds of healthcare needs, out patient, in-patient, pre-exisiting diseases with OPD benefits and more.Age group of 91 days and 65 years

1-year policy period

The plan is available for individual or family

It covers doctor’s consultation, pharmacy bills, diagnostics, health check-ups, ambulance, newborn baby expenses, and more.

It offers additional coverage for critical illness.

The policyholder can avail of tax benefits under Section 80D.
Bajaj Allianz Tax Gain PlanA family floater plan that covers OPD expenses.It offers cashless facilities across a large network of hospitals.

The policyholder can avail of tax benefits under Section 80D.

Quick and easy claim process for OPD expenses.

Coverage includes spectacles, contact lenses, dentures, dental treatment, and more.

The plan covers up to Rs 1000 for ambulance expenses.

How to buy health insurance with OPD coverage?

Insurers offer OPD coverage as an add-on to regular plans with an additional premium. Different insurance companies may have different ways in which they offer OPD coverage. Hence it is advisable to check with insurance agents or the insurance companies about the best way to include OPD coverage in your insurance plan, the premium and other details.

Enhancing your health insurance coverage with OPD coverage is a prudent move that protects your savings from regular medical expenses. It provides coverage from diagnostic, pharmacy, or doctor’s consultation expenses and provides you financial protection against the financial burden that you may incur other than hospitalization. From diagnostic and consultation expenses to expenses because of medical aids, it protects you from seemingly small yet significant OPD expenses. However, make sure that you evaluate your healthcare needs before opting for the OPD coverage. It will help you invest in the best health insurance plan with a coverage that resonates with your medical needs.

Are you surprised at how much OPD coverage can relieve you off your healthcare expenditure burden? It may be the right tool for you to help you meet your and your family’s healthcare needs. If you’d like to know about health insurance plans that offer OPD coverage, get started by sharing your query with us.

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