Know About OPD Cover in a Health Insurance Plan

Health insurance is a scheme that covers the medical treatment expenses of an individual who is insured. The costs incurred by the insured individual due to hospitalization and other medical expenses are taken care of or reimbursed to the insured individual directly or to their caregiver. There is a need for insurance plans that would take care of the outpatient department (OPD) expenses.

OPD cover allows policyholders to make their claim for expenses incurred without hospitalization. These plans cover the cost of medicines and diagnostic or minor procedures as well. The sum insured under OPD cover is calculated based on the insured's age, which is unlike other policies that pay claims based on being hospitalized.

The OPD expenses covered under insurance policies are:

• Consultation fee
• Pre-emptive medical check-ups
• Cashless OPD claims
• Pharmacy bills
• Dental treatments
• Diagnostic tests

Benefits of OPD Cover

The benefits of having OPD cover in an insurance policy are listed below:

• Less expensive in comparison to inpatient hospitalization
• Suitable for minor surgical procedures
• Access to a wide range of clinics, doctors, and medicines
• Ideal for accident-related emergencies and ambulance calls
• Control and surveillance of infectious diseases
• Provides a database of medical history and research
• Includes training for medical, para-medical, nursing staff, and future doctors.

Also Read: All About Cashless OPD

Research shows that outpatient department expenses cost around 62% of healthcare costs in India. The OPD cover that is offered under healthcare plans helps insurance policyholders cover hospitalization costs, consultation fees, and treatment costs and cover outpatient department procedures that are not hospitalized treatments. Multiple ailments do not require hospitalization but require diagnostic tests and treatments, and these costs can be covered under the insurance policy if it has an OPD cover.

If you get an OPD treatment, you are consulting a medical professional and accessing other facilities at the hospital without hospitalization. A single OPD treatment can cost a lot of money, which is difficult to bear for people. The policies which were in existence earlier did not have an OPD cover in them. Still, in recent years this has been taught into health plans making them more effective and efficient and an easy choice for the customers.

Insurance Companies Which Provide OPD Cover

Several companies offer policies with OPD cover. The prominent among them are:

1. HDFC Ergo Maxima

This plan offers various outpatient benefits and takes care of illnesses and diseases. The policy coverage contains:

• Pharmacy expenses
• Doctor consultation fees
• Diagnostic and specialist services
• Health check-ups.

2. Max Bupa Heartbeat

This policy is a comprehensive medical cover. Its coverage includes:

• OPD treatment
• Diagnostic services
• Cover for an individual as well as family

3. Bajaj Allianz Tax Gain

This policy is a family floater plan which covers:

• Hospitalization costs
• Dental procedure and treatment costs
• Crutches, dentures, and spectacles are also covered under the OPD section.

Conclusion

OPD coverage in health insurance policies is an essential feature. While considering purchasing an insurance policy, one should check to see whether OPD treatment costs are included and covered by the insurance policy as OPD treatments are relatively expensive and hence have to be covered for the policy to be effective and efficient.

You May Also Like to Read: Health Insurance with OPD Cover or Health Card?

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.​