Choose Best Health Insurance with OPD Cover Today

Out-Patient Department cover or OPD cover, when added with health insurance becomes the ultimate boon. Why? It is because it saves one from skyrocketing out-patient care expenses that account for about 62% of the overall health care costs. Visits for minor health issues, diagnostic tests, pre-emptive check-ups, and others lead one to expensive costs, especially in bigger cities. In times like such, OPD coverage helps the insured individual deal with doctor’s consultation fees, health check-ups, pharmacy bills, dental treatment, diagnostic tests, and other expenses that otherwise create financial instability.

Benefits of Buying Health Insurance Plans with OPD Cover

  • Value for money
  • Improved financial health during medical uncertainties
  • Claim for expenses other than that incurred during hospitalisation
  • Coverage for pharmacy expenses
  • Shorter waiting period in comparison to regular health insurance plans
  • Tax benefits as per Section 80D of Income Tax Act, 1961
  • Attractive discounts upon renewal if no OPD claim has been filed in the previous policy year

Best Health Insurance Plans with OPD Cover

1. ManipalCigna ProHealth Accumulate Plan

ProHealth Accumulate Plan by ManipalCigna offers OPD cover for out-patient treatment, dental treatment, optical care, consultation fees, pharmacy bills, and others. The policy features a “Personal Health Wallet” that helps policyholders keep their accumulated funds and use it to pay for OPD expenses. The amount can also be used to pay for co-pay or deductible. Moreover, the policyholder can avail an additional benefit of 5% hike on the amount available in the wallet.

Major Features:

  • OPD expenses or Personal Health Wallet options available for amounts worth Rs.5,000, Rs.10,000, Rs.15,000, Rs.20,000
  • If unused, the money accumulated in the wallet does not expire
  • Facility of carry forward at the policy renewal time
  • Sum Insured options - Rs.5.5 Lakh, Rs.7.5 Lakh, Rs.10 Lakh, Rs.15 Lakh, Rs.,20 Lakh, Rs.25 Lakh
  • Policy tenure - 1 and 2 years

2. Max Bupa Heartbeat Health Insurance

Heartbeat policy by Max Bupa, under its Platinum variant covers OPD expenses. Moreover, it also covers diagnostic tests prescribed up to sub-limits. The Heartbeat is a comprehensive individual/family floater plan that allows carry forward of the 80% of the outpatient treatment cover, in case it is not utilised in a policy year. Only the Platinum plan is inclusive of OPD expenses between Rs.10,000 to Rs.40,000, based on the sum insured.

Major Features:

  • The policy does not come with a restriction on entry age
  • Policy tenure - 1 and 2 years
  • The premium is determined based on the age of the eldest insured member in the family
  • On opting for two-year policy term, you get discount on premium

Under Platinum Plan
Heartbeat Individual and Family Floater - For base sum insured Rs.15Lakh, Rs.20Lakh, Rs.50Lakh, and Rs.1Crore, OPD treatment and diagnostic services are covered up to Rs.15,000, Rs.20,000, Rs.35,000, and Rs.50,000.

Heartbeat Family First - For base sum insured Rs.5Lakh, Rs.10Lakh and Rs.15Lakh per insured person or Floater Sum Insured (available on a floating basis over Base Sum Insured) Rs.15 Lakh, Rs.20 Lakh, Rs.30 Lakh & Rs.50 Lakh, OPD treatment and diagnostic services are covered up to Rs.35,000.​

3. Apollo Munich Maxima

Maxima by Apollo Munich is India’s first 360 degree plan. The most comprehensive medical insurance plan in India, Maxima can be issued to an individual or a family. The family coverage comes under floater basis, available for 2 adults & 2 adults + up to 2 children. It is the first Indian plan to cover both inpatient and outpatient medical expenses on a cashless basis. The most significant benefit offered by the plan is OPD coverage. For outpatient coverage, Maxima provides coupons for a free consultation with general practitioners, gynecologists, physicians, or pediatricians.

The outpatient benefits:

i) For 1 individual
Number of consultation coupons = 4
Benefits regarding diagnostic tests, pharmacy, dental treatment, and spectacles, contact lenses = Rs.5000
Annual health check-up within specified network = 1 entitlement certificate

ii) For 2 adults
Number of consultation coupons = 6
Benefits regarding diagnostic tests, pharmacy, dental treatment, and spectacles, contact lenses = Rs.5500
Annual health check-up within specified network = 2 entitlement certificate

iii) For 2 adults + up to 2 children
Number of consultation coupons = 8
Benefits regarding diagnostic tests, pharmacy, dental treatment, and spectacles, contact lenses = Rs.7000
Annual health check-up within specified network = 2 entitlement certificate

Major Features:

  • Policy tenure - 1 year
  • Premium under floater coverage is charged on the age of the oldest insured member
  • Minimum entry age - 91 days, maximum entry age - 65 years
  • If outpatient treatment is not used in a policy year, 50% is carried forward to the next policy period
  • The policy does not have maximum cover ceasing age

4. Bajaj Allianz Tax Gain Plan

Tax Gain plan by Bajaj Allianz is a family floater health policy. It provides cover for out-patient or OPD expenses along with hospitalisation expenses under a single policy. A great option for those looking for OPD cover and tax management, Tax Gain provides the insured with cashless facility through 6000+ network hospitals across the country.

Major Features:

  • No restrictions of waiting periods under out-patient expenses
  • The insured can claim for dental procedures and treatment under OPD section
  • Claim for expenses related to dentures, spectacles, crutches under OPD section
  • Cover for ambulance charges in case of an emergency up to Rs.1000
  • 130 day care procedures covered as per terms and conditions

Also Read

Covering OPD Cover in Health Insurance

Difference Between OPD Treatment & Day Care Treatment

Health insurance with OPD cover is the ideal package for individual with out-patient department expense requirements. When looking for health insurance, individuals should look for health insurance providers offering more than cover hospitalisation expenses. Costs regarding doctor’s consultation fees, health check-ups, dental treatment, pharmacy bills, diagnostic tests, and others should not go disregarded during the selection of a health insurance to make the most of it.

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