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Everything You Need to Know About OPD Insurance

Updated On Apr 27, 2021

The majority of the consultations, diagnostic procedures, and even some minor surgeries are performed conveniently without requiring a hospital stay, thanks to the advancements in medical science. This is termed as out-patient department care of OPD treatment. Though these procedures are performed on an outpatient basis, they do incur significant hospital costs and are imperative to cover them under the health insurance policy.

All About OPD Health Cover

A comprehensive health insurance policy with OPD cover will fund the medical bills that arise out of OPD treatments. OPD treatment costs include doctor consultation for any illness and injury, root canal treatment at the dentist's office, minor procedures on the ENT and other organs, etc. Policy seekers should look for health insurance policies with OPD cover with the following features.

1. Online processing:

The health insurance policy with OPD cover should make the health care claim easy, quick, and hassle-free. Most of the policies of modern times are paperless and require no hard copies, even for claims settlement.

2. Treatment in Any Hospital:

The insurance policy should cover a wide network of enlisted hospitals to seek immediate medical help even at times of emergencies. Insurance based on reimbursement is highly beneficial for OPD treatments.

3. Should Cover Pandemics:

From the breakdown of the covid-19 pandemic, many OPD health insurance policies are covering pandemics as well, as the cost of their diagnostic test and treatment spans thousands of rupees.

4. No Restriction on Room Rents and Co-Payments:

Choose a policy that offers no restrictions on room limit as some OPD procedures are performed on high-end suites like a dental suite, cardiac suite, etc. These treatment facilities incur more costs than the plain doctor’s consultation office. Also, the policy should not come with any co-payments and allow the insured to enjoy cash-free hospital treatment.

5. No Claim Bonus:

As this is the reward for staying healthy, choose plans that offer cumulative bonuses to enjoy discounts on insurance premiums.

Advantages of Health Insurance Policies with OPD Cover

The OPD expenses in the hospital include doctor’s consultation, health checkups, dental treatment, pharmacy bills, and cost of diagnostic tests. The advantages of having health insurance with OPD cover is manifold and includes the following:

  • Policies with OPD cover helps the policyholder to claim expenses that are incurred in the treatment of an illness without hospitalization.
  • These policies offer more tax benefits compared with regular health insurance policies as there are no tax-deductible sources (TDS) for its claims.
  • The policyholders can claim reimbursement on OPD expenses as many times as possible during the policy period. Thus the value of these policies is always higher than other insurance schemes.
  • These policies also cover pharmacy bills and assist those with metabolic diseases like diabetes and hypertension.
  • In insurance policies with OPD cover, the sum insured will be estimated based on the age of the insured.
  • The bills can be claimed within 90 days of availing of the insurance policy.

Bottom Line

The OPD cover does not require expenses that are incurred towards physiotherapy, spectacles, contact lenses, ambulatory devices, dietician fees, etc. But they are still highly beneficial for those with lifestyle diseases and for elders.

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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