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OPD Expense Coverage: 5 Health Insurance Policies That Cover OPD Expenses

Updated On Mar 15, 2021

OPD expenses in India account for nearly 62% of healthcare costs. And considering the factor of increasing medical inflation, OPD expenses have become out-of-pocket expenses for many, thereby impacting their monthly budget. The added expenditure is also one of the reasons why people refrain from visiting the clinic or hospitals, which may cause health issues or morbidity later. Thus, health insurance with OPD cover is the need of the hour. To know more, get into the details given below.

What is OPD Cover?

OPD is the outpatient department wherein medical cases that require the most attention are treated. The doctor conducts the diagnosis and the patient is simply required to visit the clinic and pay the required consultation fee. In a hospital, there is a general ward wherein the patient can avail of medical assistance and treatment.

In the OPD category, there is no requirement of staying in the hospital. Modern OPDs cover you for several services such as medical tests, illness diagnosis, minor surgical injuries, etc.

Benefits of OPD Expenses Coverage in Health Insurance

There are several benefits of having OPD cover under your health insurance policy. Some of them are explained below:

  • Like basic health policy, health insurance with OPD expense coverage helps you save tax.
  • OPD cover enables you to claim for expenses incurred, without being hospitalised.
  • These policies also cover the cost of medicines, with diagnostics or minor procedures.
  • Unlike policies that pay claims based on hospitalisation, the sum insured under OPD cover is determined based on the age of the insured.
  • You have the option to claim OPD expenses without a long waiting period.
  • Depending on the plan you have chosen, you can file multiple claims within the same year until the limit is exhausted.

Top 5 Health Insurance With OPD Cover to Buy in 2021

Here are top 5 health insurance plans under which you can avail OPD cover:

1. Bajaj Allianz Tax Gain Plan

Available with sum insured options starting from Rs. 1 Lakh, this policy can be purchased by people aged between 18 years and 75 years. Apart from OPD cover, the policy protects you from emergency hospitalisation expenses, daycare procedures, pre-hospitalization and post-hospitalisation expenses, etc.

2. ICICI Lombard Complete Healthcare Policy

Complete Healthcare Policy secures you against sudden medical expenses. The policy, apart from OPD expenses, covers you for maternity expenses, critical illness expenses, organ donor expenses, daycare treatments, treatments taken under AYUSH systems of medicines, etc. You can choose the add-on cover of OPD benefit by paying an extra premium under the policy.

3. Max Bupa HeartBeat Policy

Available for people aged at least 18 years, the policy can be purchased for sum insured options starting from Rs. 1 Lakh. The coverage benefits that HeartBeat policy offers include newborn baby expenses, AYUSH treatment expenses, in-patient hospitalisation expenses, pre-hospitalisation and post-hospitalisation expenses, etc.

4. HDFC Ergo Health Wallet Policy

Another reliable policy that offers OPD cover is HDFC Ergo’s Health Wallet. You can be covered under the policy if you are aged between 91 days and 65 years for several coverage benefits such as free annual health check-ups, worldwide emergency coverage, etc.

5. Max Bupa Go Active Policy

Max Bupa’s GoActive policy is a good option for people looking for OPD cover in their health insurance policy. The policy covers people aged between 91 days and 6 years for sum insured options starting from Rs. 4 Lakh. The coverage benefits include daycare treatments, pre-hospitalisation and post-hospitalisation expenses, domiciliary hospitalisation expenses, etc.

Things to Remember While Purchasing Health Insurance with OPD Cover

In order to stay on the safe side, it is important to ensure appropriate health coverage. As buying an insurance policy which is incapable of meeting your requirements is not worth it, the same thing applies for an OPD cover. In case, the insurance coverage is insufficient then your pockets can get adversely affected. So, highlighted below are some tips to consider while buying a health insurance policy with an OPD cover in India:

  • Select the Amount of Coverage Wisely: You should choose the amount of coverage carefully and wisely as an adequate sum insured would mean that you are covered extensively under the health insurance policy. Additionally, at the time of selecting an OPD cover, do not forget to look for the procedures that are there in the insurance policy.
  • Ensure Insurance Company’s Credibility: At the time of purchasing an insurance policy, it is recommended to always consider a renowned insurance company in India. By doing this at one side you will ensure receiving the entire policy coverage that has been assured while buying the plan and an insurance company with a good claim ratio would mean they would be upfront on settling the claim on time. This reduces the chances of your claim getting rejected.
  • Check for Co-payment Clause: It is highly recommended to go with an insurance company that offers the OPD cover alongside the health insurance plan with no age related co-payment clause.
  • Waiting Period: Waiting period clause is one of the most important factors to look for at the time of buying a health insurance plan. Most of the time, a health insurance plan is offered along with a waiting period clause for the pre-existing ailments. This may also be applicable while talking about OPD coverage. All the critical illnesses and diseases such as diabetes are not given coverage right after the issuance of the policy, a pre-decided waiting period is always applicable. Therefore, while selecting an insurance policy look for a plan that comes with a minimum waiting period.


Investing in health insurance plans that offer additional coverage benefits not only helps you save more but also lets you avail of timely treatment without financial worries. So, even if your health insurance policy does not offer OPD cover, you can opt for it as an add-on benefit if there is an option for the same. Stay healthy, stay insured!

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.

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