Why Cashless OPD Health Insurance Important? Benefits & Coverages
An individual buys health insurance to get coverage against financial expenses during hospitalization. In most cases, the coverage is provided if the policyholder is hospitalized for 24 hours or more. In some instances, daycare procedures like cataract surgery, etc., which do not require 24-hour hospitalisation are also covered. The insurance companies are moving a step ahead to introduce further benefits to the policyholder. Cashless OPD or OPD cover is a refinement in the health insurance industry. It is introduced to give more flexibility and comfort to the policyholder.
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What Is OPD Health Insurance?
OPD insurance is a feature where the policyholder’s benefit is not limited to just in-patient hospitalisation, but outpatient hospitalisation benefits are also covered. There is no need for 24-hour hospitalisation to get the benefit. The health insurers offer coverage for outpatient department (OPD) treatment. This includes consultation fees, diagnostic tests, dental treatment, the cost of eyewear or contact lenses, medicines, etc.
Benefits of Cashless OPD Cover Insurance
Check the benefits of the OPD Insurance plan which are mentioned below:
1. Coverage for Outpatient Expenses
The most commonly incurred medical expense by a policyholder is OPD expense. Medical bills, consultation fees, diagnostic tests, etc. are generally not covered under a regular inpatient cover. However under health insurance with OPD coverage, these expenses are also covered by the insurance companies. People with diabetes, asthma, or young children often need regular check-ups and practitioner visits. In such situations, OPD cover provides great relief.
2. Health Insurance Tax benefit on OPD Coverage
There are more tax benefits when compared with regular health plans. There is a tax exemption under section 80D on the premium amount paid for plans with OPD cover. The policyholder can claim for expenses not paid under regular health policies for tax exemption. This is a lucrative move for those who spend a sizable amount on pharmacy bills.
3. Multiple claims
The insured can claim for reimbursement numerous times during the policy period. He can claim the coverage as many times as he visits the practitioner or buys medicines. It includes several services and hence the number of transactions. This makes the health insurance policies with OPD coverage more welcoming.
4. Coverage based on age
Under regular health insurance policies, the claim and sum assured are determined based on 24-hour hospitalisation. But, under OPD cover, the sum assured is based on the insured’s age.
5. Less waiting period
The benefit under OPD cover can be claimed within 90 days of availing of the policy.
6. Cashless coverage
When this concept was introduced, it was based on reimbursement. The policyholder has to pay for the doctor’s bill or medicine and is later reimbursed by the insurance company. But with the advent of coverage of OPD expenses in health insurance, the companies are providing vouchers to the policyholders, which can be en-cashed during the consultation and paying pharmacy bills. Thus, it offers more convenience to the insured in terms of managing medical expenses.
Challenges of Cashless OPD
The cashless OPD feature is still in the experimental phase. No doubt where there are benefits, there are also some caveats involved.
1. Network hospital
The hospital you are visiting must be within the network hospital of the insurer.
2. Sub-limit
The cashless voucher provided to the insured has a certain sub-limit. It varies from as low as Rs. 500 to Rs. 10,000. Thus, be wary of the sub-limits while availing of the OPD cover.
3. Capping on transactions
There is capping on the number of transactions. Some insurers may allow one settlement once a year, while others may be open for multiple claims.
4. Method of claim
There is a restriction on the process of the claim settlement. Many insurance companies may only allow reimbursement while some may provide cashless coverage.
5. OPD type
There is a restriction on the type of OPD. Some providers may restrict it to items like vaccinations, dental procedures, or spectacles only.
6. Visit to listed providers
Many insurance companies have a tie-up with online health service providers such as Practo and 1Mg to book appointments for doctors. The policyholder can avail the benefit of cashless OPD only if he is visiting the physician listed in these health service providers. A person cannot go to just about any doctor and claim the coverage.
7. High premium
The premium for these policies is higher than regular policies. While buying the plan, analyze whether the benefits justify the cost of your health requirements and age. For example, the plans that cover hearing aids and spectacles are more suitable for older people.
Check Top Health Insurance with OPD Benefit
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Plan |
Cashless OPD Benefit |
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Provides both cashless and reimbursement OPD coverage. The number of OPD visits depends on the sum assured. The coverage limit is Rs. 600 for zone 1 and Rs. 500 for zone 2. There is a tie-up with online service providers like Practo and 1Mg to book appointments online |
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Provides reimbursement OPD coverage benefit. OPD limit depends on the sum assured |
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ManipalCigna (ProHealth Preferred, ProHealth Premier and ProHealth Accumulate) |
Coverage for alternative medicines, preventive health check-ups, bonus on unutilized OPD amount year on year. OPD limit up to Rs. 20,000 depending on the sum assured |
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Bajaj Allianz Tax Gain Plan |
Outpatient department expenses such as the cost of dentures, spectacles, crutches, dental treatment, dental procedures, etc. are covered. No restriction on the waiting period to claim under outpatient expenses. The sub-limit for coverage is up to Rs. 9000 depending on the age and family size. |
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The OPD limit under this policy ranges from Rs. 10,000 to Rs. 40,000 depending on the sum assured. If outpatient treatment is not utilized during a policy year, 80% of the same is carried forward to the next policy year |
Conclusion
Increasing medical costs is becoming a significant concern for the people. Health insurance with OPD coverage is a lucrative move by the insurance company. OPD coverage provides a valuable benefit, but analyze the utility value and the cost of the plan before investing in a plan. You can contact us at Insurancedekho.com to learn more about the cashless OPD plans and get comprehensive coverage against all your medical expenses.
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