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What Is OPD Treatment In Health Insurance?

Published On Oct 19, 2022 10:20 AM By InsuranceDekho

Even though outpatient medical costs can add up over the course of the year and drain your bank account, in-patient medical costs typically run significantly higher. It makes sense to select a medical insurance plan with OPD coverage given the escalating expense of healthcare. To find out more on OPD treatment in health insurance, read on.

What Is OPD Treatment In Health Insurance?

What Does OPD Treatment Mean In Terms Of Health Insurance?

Not every medical condition necessitates hospitalisation. In these situations, you may go to the hospital's clinic or Out Patient Department, have the doctor evaluate your  medical condition, perhaps need a lab test to diagnose it, and then purchase medications from the pharmacy to treat it. You pay for medical consultation fees, lab tests, and medications as part of these services.

Such costs are not covered by standard health insurance policies, leaving you financially strapped. However, it is important to note that  modern day health insurance providers have created plans that cover OPD costs. The OPD cover aids the insured in reimbursing costs that aren't paid for as in-patient charges.

Why Should Someone Buy Health Insurance With OPD Coverage?

OPD coverage from health insurance policies enables the insured to file claims for costs other than those spent during hospitalisation. There are additional tax advantages attached to these plans compared to standard health insurance policies. Tax exemptions are available to policyholders for the premiums paid towards health insurance plans. In most health insurance policies with OPD cover, the insured can claim reimbursement on expenditures numerous times during the policy year. The vast range of services offered by outpatient health care results in a higher volume of transactions.

Due to this, a health insurance policy with OPD coverage has a higher financial value than a standard health insurance policy. This coverage also pays for pharmaceutical charges, helping people with higher costs associated with the same.

Conventional health insurance policies basis their claims and sum guarantee calculations on a 24-hour hospital stay. The OPD Cover's sum assured is determined on the insured's age. Within 90 days of acquiring the health insurance coverage, OPD charges may be claimed.

What Is The Necessity For Someone To Get OPD Coverage?

Following reasons can be taken into account for an individual to get OPD Coverage -

  1. Need - Numerous chronic illnesses are being brought on by an increasing sedentary lifestyle, which raises the price of medicine overall. To be able to pay for everyday medical expenditures without worry, it is important to have health insurance that includes coverage for inpatient care.
  2. Healthcare Documentation - Even though we don't have a well-organised national health records system, insurers are very cautious about taking on risks. One can benefit from the outpatient care with an OPD treatment plan without having to cope with the effects of operational problems.

Who Should Invest In OPD Coverage In Health Insurance?

Following are the individuals who should invest in health insurance -

  1. Sports Enthusiast - If you enjoy physical activity or are a sports enthusiast, you should choose a health plan that includes OPD coverage. This is due to the fact that individuals are often prone to injuries when participating in sports or fitness activities, and having a health plan with OPD coverage would protect you from such costs.
  2. Senior Citizens - Seniors are more susceptible to illnesses and are often more likely to need OPD procedures like dental work and minor operations. In order to assist cover both normal health insurance benefits and OPD treatments, it is crucial for them to think about enrolling in a health plan with an OPD cover. Having health insurance that pays OPD costs would save people from having to dig further into their wallets when they see the doctor.


There are a number of ailments that can only be addressed using medications that doctors have recommended. Sometimes, these medical appointments may last for a longer time, which frequently strains your finances. Therefore, before purchasing a health plan, confirm if the OPD is covered by it and obtain coverage for your consultations, diagnoses, and treatments.

Also Read: Medical loans or health insurance plans?


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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