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What is OPD Cover? Know OPD Cover Benefits, Features & How it works
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What is OPD? Comprehensive Guide to OPD Cover

Visits to hospitals can be a bit challenging morally as well as financially. Not a lot of us would want to visit hospitals but certain things need the attention of doctors. You cannot skip visiting a hospital in such cases. Fortunately, one doesn’t have to be hospitalised for recovery or diagnosis of all the conditions. In such cases, OPD comes into the picture. 

OPD or Out Patient Department is where you can avail of doctor’s consultation, any diagnosis, and treatment without having to stay for a longer duration. 

What is OPD?

There are quite a few illnesses or diseases that do not require the patient to be admitted. Yet, they might still need access to a doctor’s consultation, healthcare facilities, diagnosis, etc. When it comes to the outpatient department, dental procedures, minor injuries, fractures, or minor surgeries are common examples.

And the expenses related to such procedures or conditions are outpatient department charges. The OPD charges at times can easily burn a hole in your pockets. To avoid such sudden financial perils, it is advisable to opt for a health insurance plan with OPD cover

OPD in Hospital

What is OPD Benefit?

As we have already discussed, any expenses pertaining to the outpatient department are known as OPD expenses. And they can at times be enough to unsettle your finances. Health insurance that offers OPD benefits ensures that you can claim the OPD expenses as well.

Depending on your health insurance plan, it can be in two different flavours. You can either buy a health plan that offers OPD benefits as a part of the native plan. Or you can opt for OPD cover along with your health insurance plan as an add-on. 

Should you opt for OPD cover, it pretty much acts like a normal health insurance plan. During an OPD visit to a network hospital, you can avail of cashless benefits. And in the event that you do not, you can always reimburse the amount.

Should you Opt for One?

It is quite possible that you are on the edge of whether to opt for an OPD cover or not. If that is the case, here are some more prominent reasons to seriously consider the OPD cover.

  • Of the total healthcare-related costs in the country, OPD accounts for a strong 62%.
  • With more people striving for a healthy life and more of them opting for gyms and workouts, the number of niggles and injuries is also on the rise.
  • That has been a steep rise in the number of visits to doctors in recent years. While 2017 saw a 2.7 times rise, 2018 witnessed a 3.2 times rise.


People belonging to the following categories should also consider going for an OPD cover along with their health insurance plan.

  • Senior Citizens: It should not come as a surprise that the list contains senior citizens. They are more prone to health-related issues and it makes even more sense to opt for OPD cover. With growing age, the possibilities of dental issues and minor treatment increase several folds. With an OPD cover, senior citizens no longer must worry about paying these expenses from their pockets.
  • Fitness Buffs: People who take their fitness seriously should also consider buying the OPD cover. A lot of injuries and niggles come out of workouts and gyms. If you spend a considerable amount of time in either of them, it is advisable to opt for the cover. Also, a health insurance plan will ensure that you receive tax benefits as well.
  • Working Professionals: Working individuals almost always have a group Mediclaim cover. However, a lot of these group Mediclaim covers are not adequate and can leave you asking for more. In such cases, opting for a super top-up plan or another additional health insurance plan with OPD cover makes a lot of sense. It will not only extend the benefits of what your employer is providing but also give you tax benefits.
  • 25-40 Years Age Group: Young individuals belonging to the 25-40 year age bracket are opting for health insurance plans more often. Since they are young, they can get access to health plans at more affordable rates. Also, they stand to benefit from tax breaks. If you belong to this age group and a health plan with OPD cover is ideal.


Inclusions and Exclusions of OPD Cover

Health plans with OPD cover usually have the following inclusions.

  • Cover for family members between 95 days and 65 years.
  • Discounts for certain lab and diagnostic tests.


Here are some exclusions of the OPD cover.

  • Expenses related to cosmetic surgeries.
  • Expenses related to injuries that are self-inflicted.


An OPD cover will ensure that any expenses related to the outpatient department are taken care of. With the ever-increasing medical expenses, the OPD cover is a small investment that offers greater benefits.

What is OPD FAQs

What OPD means?

The full form of OPD is Outpatient Department Treatment. It is a treatment given by a doctor when a patient visits an outpatient department in a hospital.

What is the function of OPD?

The main function of an OPD is that it provides medical treatment without getting admitted to the hospital. Nowadays, modern OPDs even offer surgical injuries, diagnosis, and medical testing.

What are the types of OPD?

There are different types of departments that together make an OPD in a hospital for instance:

• E.N.T.
• Skin or Dermatology
• Dental Care
• Gynecology
• Orthopaedic Department
• Pharmacy
• Emergency Department
• Surgery
• Diagnostic Department

What are the problems in OPD?

The only big problem found by patients in an OPD is the big waiting in the waiting room to get medical treatment. Patients often need to queue to get medical assistance in such OPDs.

What are the key issues in OPD?

One of the main issues in an OPD is the long waiting period and queue to get the treatment. Secondly, sometimes, there is a shortage of doctors to treat and attend to the patients. Thirdly, due to the over-rushing of patients, sometimes the doctors don’t listen to the patients carefully to prescribe them the right treatment.

How can OPD reduce waiting time?

The following tips can help an OPD reduce waiting time:

1. Implementing a patient flow management system
2. Implementing pooled queues
3. Appointing medical staff to examine the patients and record their medical history before they visit the main doctor
4. Using a Queue App
5. Using a Patient Portal
6. Introducing Slack in the OPD Timing
7. Strict Policy for Late Patient Arrival

What is OPD limit?

Generally, all reputed health insurance companies offer an OPD coverage of up to Rs. 1 lakh sum insured, or 0.5% of the sum insured, whichever is less is applicable.

What are OPD charges?

The OPD charges may vary from state to state and hospital to hospital. The standard OPD charges however are usually between Rs.1,000 to Rs. 2,000 for the first-time visit and Rs. 1,500 for the follow-up visit.

How do I claim OPD?

To claim OPD coverage, you need to get an OPD treatment at any network hospital of the insurer and submit the insurance forms to initiate the cashless claim procedure.

What is OPD and maternity benefit?

These days, most health insurance companies offer OPD and maternity benefits. They offer reimbursements for medical expenses that are incurred on outpatient department treatments like doctor consultations, diagnostics, and so on. Some health insurance companies also offer special maternity benefits and even new-born baby expenses from day one of the birth or when the baby turns 91 days.

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