Health Insurance with OPD Cover

September 28, 2020

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Health Insurance with OPD cover

Did you know 62% of the total healthcare costs in India are towards outpatient department expenses? Yes, it’s true! Several medical conditions like minor injury or illness do not require hospitalization for more than 24 hours. If you’re suffering from any such medical condition, you can easily recover with proper doctor consultation, diagnosis, treatment, and medications. But, these costs can eat a large chunk of your savings. Therefore, choosing a healthcare benefit plan with OPD cover is best. 

Read on to know everything about OPD expenses, eligible medical conditions, benefits of OPD covers and much more.

What is the outpatient department expense?

As stated earlier, not all medical expenses require hospitalization. For instance, in case of minor injury or illness, you may require visiting the clinic or the OPD of the hospital. Once you visit the doctor, he may prescribe medicines and a series of medical tests. You bear these expenses along with the doctor’s consultation fee. A regular health plan does not provide coverage for such expenses. But, many health insurance plans nowadays offer coverage for OPD expenses that you can claim.

Benefits of OPD cover in health insurance

Given below are several benefits of OPD cover in health insurance

  • Claim medical expenses without being hospitalized
  • Get coverage for doctor consultation fees, diagnostic and pharmacy bills
  • Get access to a wide range of clinics and hospitals in which you can avail OPD cover
  • Avail tax benefits
  • Reduces financial burden for those with pre-existing medical conditions or chronic medical conditions that require multiple OPD visits

Inclusions of OPD cover in health insurance

OPD cover in health insurance includes the below:

  • Doctor consultation
  • Diagnostic tests
  • Pharmacy expenses
  • OPD treatment

Exclusions of OPD cover in health insurance

Given below are the exclusions of OPD cover in health insurance

  • OPD treatment outside India
  • Cost of implants, hearing aids, lenses, braces, etc. is not covered
  • Routine examinations
  • Services or facilities availed for pleasure, rejuvenation, etc.
  • Infertility treatments
  • Complications arising out of pregnancy, miscarriage, etc.
  • Dental and surgical treatments
  • Investigational treatment
  • Treatments related to panchakarma, purification, detoxification

Who should buy health insurance with OPD cover?

It is best to buy health insurance plan with OPD cover for individuals falling in any one of the following categories –

  • Fitness enthusiasts who may require frequent doctor visits for workout related injuries
  • Senior citizens who may require dental treatments or other minor surgeries
  • People aged between 25-40 years

With the rising medical costs in India, you must ensure that the insurance provider offers coverage for OPD before buying a health insurance plan.

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