OPD Cover in Health Insurance

This cover has been designed with the view that not all medical treatments require hospitalisation. The treatment itself requires you to be only in the doctor’s chamber rather than in an operation theatre.

Let’s find out more about OPD cover in this write-up. 

Difference Between OPD and Day-care Treatment

While some people may confuse OPD with daycare treatment, it’s important to understand that both are completely different. Mentioned below are some grounds of distinction -

• The Nature of Treatment - An OPD is basically a treatment that can happen within the physician or the doctor’s room and does not require hospitalisation. 

Day-care treatment, on the other hand, requires a patient to be hospitalised for treatment (for less than 24 hours). 

• Claim Settlement Procedure - Under OPD treatment, the claim settlement can be filed only for treatments that don’t require hospitalisation. In the case of daycare treatment, you cannot file a claim if the hospitalisation is for more than 24 hours.

Why Do You Need an OPD Cover?

Here’s why you should opt for a health insurance plan with OPD coverage -

• One of the main reasons to opt for a health insurance plan with OPD cover is that it offers additional protection that is usually not provided under standard plans. 
• You can file for multiple claims when you have an OPD cover around the policy year for reimbursements. This is possible till the time the claims are within the maximum limit of the OPD cover. 
• This cover is ideal for patients who have to frequently visit the OPD for regular check-ups and for treating illnesses as basic as viral fever. 

Benefits of Outpatient Department Cover

Discussed below are the key advantages of OPD cover -

• Reduced Out-of-pocket Costs - The cover reduces the financial burden of out-of-blue popped-up outpatient treatments like consultation charges, prescribed medications, and diagnostic tests.

• Convenient - OPD cover offers peace of mind to patients when it comes to costs related to minor illnesses. This cover allows them to seek immediate medical attention to get better health outcomes. 

Features of Physician Consultation Cover

The following are the main features of the outpatient department cover -

• It usually covers the initial medical screening stage before hospitalisation is required. 
• The sum insured offered is subject to factors like age and medical history. 
• Vaccines for dog bites are covered.
• Access to world-class OPD treatment and physician consultation is available with this cover.  

Inclusions under Outpatient Department Cover

Under the outpatient department cover, a policyholder is usually covered for the following services -

• Pharmacy costs
• Diagnostic tests
• Physician consultations
• Medical investigations

With this cover, you can have a financial safety net for your savings and get the right treatment without having to worry about the costs. 

Exclusions under Outpatient Department Cover

Listed below are the major exclusions under OPD cover -

• Claims for services related to rejuvenation
• Treatments such as purification panchakarma, detoxification, and more
• Costs of optics, dentistry, implants, prosthetic devices, and more
• Sterility or infertility treatments
• Complications in pregnancy

Who Should Buy a Health Insurance Plan with OPD Consultation Cover?

Health insurance with OPD cover is suitable for anyone looking forward to expanding their basic health insurance plan for coverage beyond hospitalisation. Generally, individuals belonging to the following categories can opt for OPD cover under their health insurance plan -

• Patients who suffer from immuno-repressive disorders and require regular check-ups
• Individuals suffering from chronic medical conditions like diabetes, asthma, thyroid, arthritis, and so on
• Patients with pre-existing medical conditions that frequently require physician or specialist consultation

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Frequently Asked Questions

Q1. When can you use OPD coverage?

Ans: OPD coverage under a health insurance plan is suitable to be used in case of minor procedures or treatments that don’t require any kind of hospitalisation. 

Q2. Is there any limit on OPD expenses under your health insurance plan?

Ans: The limit on OPD under this cover is determined as per the policy wording and is part of the sum insured. Any claims made under OPD cover get subtracted from the overall sum insured.