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

Published On Jan 29, 2020 5:30 AM By Prashant Srivastava

Don’t you think OPD expense coverage is necessary in health insurance?

Yes, it is.

OPD expense should be covered in health insurance policies.

After all, health insurance with OPD coverage takes care of the outpatient department (OPD) expenses. So, there is a need for it.

According to a report,

  • Out-of-pocket medical expenses account for 62% of all healthcare costs in India.
  • And OPD products have so far failed to become popular due to various reasons.

Over the last few years, health insurance companies in India mostly cover hospitalization charges. However, with the passage of time, many insurance providers have expanded the scope of products. They now cover OPD expenses, including:

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

In this article, we are going to discuss the following points:

  • What is OPD treatment?
  • OPD Cover in health insurance
  • Health insurance plans with OPD cover
  • Benefits of health policies with OPD coverage
  • Why should you buy Health Insurance with OPD expense coverage
  • Who should take OPD cover
  • What is covered under such plans, and much more?

What is OPD Treatment?

Medical treatment is not merely limited to hospitalisation, but also diagnostics, check-ups, post-surgery consultations, etc. and so on. OPD treatment is the one in which you visit a hospital/clinic/healthcare center or any other recognized consultation room for the diagnosis and treatment advised by your medical practitioner or doctor. The treatment does not require admission/hospitalisation.

OPD Cover in Health Insurance

With OPD expense coverage, health insurance provides coverage for several daycare procedure expenses, like diagnostic tests, medical bills, ambulance charges, health check-ups, dental treatments, etc. irrespective of the patient is not admitted.

Health Insurance Policies with OPD Coverage

Many insurance companies have rolled out health insurance products with OPD cover. Some of the policies with the cover include:

  • Apollo Munich Maxima - Apollo Munich Maxima plan offers unique out-patient benefits. It takes care of regular illnesses and diseases. The policy coverage includes pharmacy expenses, doctor’s consultation fee, diagnostics, specialist services, health check-up under the OPD Section.

  • Max Bupa Heartbeat - This health policy of Max Bupa is a comprehensive medical cover. Available on the individual basis, the policy can also cover extended family. It covers OPD treatment and related diagnostic services and/or prescribed medicines.
  • Bajaj Allianz Tax Gain -Tax Gain Plan by Bajaj Allianz is another health policy to cover OPD treatment expenses. This family floater plan also covers hospitalization costs, and expenses related to dental procedures & treatment, crutches, dentures and cost of spectacles, among others under the OPD section.
  • Max Bupa’s GoActive: GoActive is another health insurance product that covers OPD expenses. It features to provide coverage for annual check-up per adult, diagnostics and 10 cashless /reimbursable OPD consultations.

Benefits of OPD Expenses Coverage in Health Insurance

Many people don’t understand the importance of OPD cover. This is because they don’t know how often they would visit the hospital or whether the doctor would suggest getting an x-ray, blood test, scan, etc. They are unaware of the fact that out-of-pocket medical expenses account for more than 60% of all health care costs in India.

Here are key highlights of OPD expense coverage in your health insurance:

  • Like basic health policy, health insurance with OPD expense coverage saves tax.
  • OPD cover enables policyholders to claim for expenses incurred, without being hospitalized.
  • These policies also cover the cost of medicines, with diagnostics or minor procedures
  • Unlike policies that pay claims based on hospitalization, 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.

Also Read

6 Points to Consider Before Purchasing a Second Health Insurance Plan

Bajaj Allianz - An Affordable Health Insurance Choice


Expenses related to OPD may not appear to be a huge amount for you, but it may cost you a lot due to the rising medical inflation.

To stop paying OPD expenses from your pocket, give us a call on our toll-free number 1800-120-5698 and get the best health insurance policy with OPD coverage benefits.

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