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In order to avoid having to pay the high cost of treatment in the midst of rising inflation, many of us take the help of health insurance. But despite taking health insurance, we still may have to spend a lot on OPD (Outpatient Department). This is because OPD is usually not covered under health insurance policies. OPD is for minor medical treatments that do not require admission to the hospital. In India, 62% of the total healthcare cost is spent in the OPD and given the rising inflation, even OPD expenses can be unaffordable for some people. If someone has to spend at the OPD even 2-3 times in a month, then their budgeting for the whole month could get spoiled. This is the reason that people are shying away from going to the doctor or hospital for minor ailments nowadays. As a result, it is becoming difficult to catch diseases in the early stages. Perhaps this is the reason so many health insurance companies are introducing policies with OPD cover. If you take myUpchar Bima Plus Health Insurance, then under this you do not even need to worry about doctor consultation, because it comes with a 24x7 free tele-OPD facility.

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  1. OPD cover in health insurance
  2. What is included in OPD cover in Health Insurance
  3. What is not included under OPD cover in health insurance
  4. Benefits of OPD cover in health insurance
  5. Who needs OPD cover with their health insurance

When a patient goes to the hospital or local doctor for treatment of their health problem, the consultation is called OPD. Generally, you do not get any kind of insurance cover for these services or facilities and have to pay for them yourself. Adding such expenses can badly affect the budget of any person and your savings can become exhausted in some cases. This is why you need OPD cover in health insurance, which can be taken as a rider. If you have opted for OPD cover, then you can get your OPD bills reimbursed by the insurance company. 

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OPD cover provides a financial cushion at the time of minor illnesses. Before you reject the OPD cover, know that it includes the following :

  • Diagnostic tests
  • Doctor consultations
  • Investigative tests
  • Pharmacy expenses (medicine bills)

By taking OPD cover, you can ensure that you won’t need to dip into your savings for the treatment of minor ailments in the future.

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No health insurance policy covers every type of treatment, nor is it possible to do this with the help of a rider like OPD cover. Following are a few services that are not covered in OPD cover:

  • Services taken for rejuvenation or pleasure
  • Treatments like beautification, purification, detoxification and Panchakarma
  • Cost of glasses, lenses, implants, hearing aids, prostheses, braces, etc.
  • Out-of-country treatment in OPD
  • Routine checkups or preventive health checkups
  • Vaccination or immunization to prevent a problem (however, animal bites do include vaccination)
  • Investigational treatment or experiment
  • Treating impaired fertility and other related conditions in men and women
  • Complications arising due to pregnancy or miscarriage
  • Dentures, dental treatments and other similar surgeries

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You already know about the many benefits of health insurance, the following are some ways in which OPD cover can be beneficial for the insured:

  • Expenses of those who have to visit the doctor frequently due to minor problems are covered under this.
  • Inflation is increasing wildly and the medical sector is no exception to it. Doctor's fees and medicines bills go into the thousands. All pharmacy bills are taken care of under OPD cover.
  • Diagnostic charges are included in the OPD cover. If you have OPD cover then you will not have to postpone getting any tests done due to being short of money.
  • In the case of chronic diseases, OPD cover will save you from hefty bills for when you have to visit the doctor and buy medicines - before and after the pre and post hospitalization deadline.
  • If you have taken OPD cover then you can be worry-free about OPD expenses throughout the year.
  • If you have a family floater policy then the whole family gets the benefit of OPD cover.
  • You get income tax exemption on the premium paid for OPD cover.
  • In this digital age, you can sign up for this rider online, without the need for any paperwork.

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Many people do not develop any disease or suffer from an injury that would require hospitalization for many years. But almost everyone goes to OPD once or twice a year to consult a doctor for the treatment of one or the other problem. OPD cover in health insurance is essential for everyone, but especially so for the following people:

  • OPD cover can prove to be a boon for people who fall ill often due to weak immunity.
  • Middle-aged people should also take health insurance that covers OPD expenses, diagnosis of diseases, medical checkups and other minor surgeries.
  • OPD cover is a must for those people who suffer from chronic diseases like diabetes, asthma, arthritis, etc and need to frequently visit the doctor for consultation.
  • Apart from this, if you have small children in your house then it’s best for you to take OPD cover along with your family floater health insurance.

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