• OPD expenses cover in health insurance Explained

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    Back in the days, most health insurance policies in the market offered hospitalisation-only coverage. While this type of coverage offered a lot of benefits, many customers felt this cover to be inadequate against the minor health issues people face on an everyday basis. Amidst these raising concerns, many insurers in the market have started offering health insurance policies with coverage for outpatient department (OPD) expenses. This additional coverage started providing coverage for various expenses such as medical bills, diagnostic tests, ambulance charges, health checkups, dental treatments, etc. Though these medical costs are minor compared to hospitalisation expenses, they can accumulate over a period of time and result in a huge financial loss.

    An OPD cover offers protection against these financial threats faced by policyholders. Some of the top insurance companies in the market including Cigna TTK, Apollo Munich, Bajaj Allianz, ICICI Lombard, etc. have health insurance policies that cover OPD expenses incurred by policyholders. OPD covers typically come under regular health insurance plans, or they can be availed as add-on covers. When a health insurance policy covers both hospitalisation expenses and OPD expenses, the overall risk faced by the insured person is mitigated.

    Why we should opt for OPD expenses cover?

    It is estimated that the health industry is witnessing inflation to the tune of 15% to 20% every single year. With this significant rise, various medical expenses including costs of medicines and health checkups are skyrocketing over the last few years. In this time, additional coverage for various costs including OPD expenses are becoming increasingly crucial. With a policy that offers this coverage, the overall financial troubles associated with everyday medical expenses can be significantly minimized.

    Features of OPD expenses cover

    Some of the key features of OPD cover in health insurance can be listed as follows.

    • Tax benefit in OPD expenses cover is typically higher than that of regular health insurance. In addition to the premium charges paid, the claim amount obtained from this policy is also eligible for tax relief.
    • Since OPD expenses occur multiple times in a year, it is possible to make multiple claims within the same year in an OPD cover.
    • This policy covers drugs and medications. People who might have to regularly take drugs can use this cover to minimize these expenses.
    • In regular health insurance policies with OPD coverage, there is a generally a sub-limit for various everyday medical expenses.
    • For people with certain conditions like diabetes and hypertension, OPD cover might cost extra since they are prone to frequent hospital visitations and high medical bills.

    Health insurers that offer OPD cover

    There are many health insurance service providers in the market that offer coverage for OPD expenses incurred by policyholders. Some of the plans with OPD coverage can be listed as follows.

    ICICI Lombard - Health Protect Plus, Health Smart, Health Smart Plus ICIC Lombard offers these three health insurance plans with OPD cover. Here, reimbursement is offered for all the OPD expenses incurred by the insured. To claim the expenses, the insured must submit all the original bills, receipts, diagnostic reports, etc. to the insurer.
    Apollo Munich Maxima Maxima is a health insurance policy that offers unique coverage for all OPD expenses. Though this also covers in-patient hospitalisation, its main focus is on providing coverage for minor outpatient hospital visits. This can be taken as an individual cover or a family floater cover. There are various sub-limits within the policy for certain medical expenses. Some of the treatments that can be availed under this cover include - diagnostic tests, pharmacy bills, spectacles, contact lens, dental treatments, emergency ambulance, etc.
    Bajaj Allianz Tax Gain Plan This is a family floater plan that covers both hospitalisation expenses and outpatient expenses. One of the highlights of this cover is that there is no waiting period restriction for claiming outpatient treatment expenses. A range of outpatient expenses including dental treatments can be covered in this plan. Other expenses including cost of spectacles, crutches, dentures, etc. are also covered under this policy. There are specific sub-limits for various conditions. Detailed information about the sub-limits and other related terms can be found in the policy document.
    Max Bupa Heartbeat Many individual plans and family floater plans offered by Max Bupa provide coverage for OPD expenses incurred by the policyholder. The maximum limit available under the OPD cover varies based on the plan (gold & platinum) and the sum insured chosen. Any reasonable expenses incurred towards medically necessary conditions can be claimed from the insurer. Consultations and diagnostic tests incurred by the policyholders can also be covered under this policy.
    Cigna TTK ProHealth There are different health insurance plans offered by Cigna TTK. Most of these plans have provisions for outpatient expenses incurred by the policyholder. OPD coverage is offered for various medical expenses including diagnostic tests, drugs, consumables, doctor’s consultations, etc.

    Most people do not focus on OPD cover when taking a health insurance plan for themselves or their families. This is mainly because OPD expenses are not that huge when spent on a everyday basis. However, OPD visits are more frequent and they cost a lot when accumulated over a whole year. Considering the costs of today’s medical expenses, it is worth having this additional cover. Moreover, a little extra money spent on premiums can go a long way in providing complete protection against all health hazards.

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