What is OPD Expenses Cover in Health Insurance?
Outpatient Department Cover, also known as OPD Cover, is a new feature that is offered as a part of policies by many health insurance providers, including ICICI Lombard, Bajaj Allianz, Apollo Munich, etc. An OPD Cover provides cover of doctor’s consultation fees, pharmacy bills, diagnostic tests, health check-ups, etc.
Most health insurance providers only cover hospitalization expenses and this limits the scope of cover for Out Patient Department expenses. These expenses include doctor's consultation fees, health check-ups, pharmacy bills, dental treatment, diagnostic tests, etc.
What is Covered Under OPD Cover?
The following things are covered under the OPD Cover -
- Pharmacy expenses
- Doctor consultations
- OPD treatment
- Diagnostic tests
What is Not Covered Under OPD Cover?
The following things are not covered under OPD cover -
- The cost of spectacles, lenses, implants, hearing aids, prosthetic devices, braces, and other such items.
- Facilities and activities done for one’s rejuvenation
- Routine and preventive check-ups
- OPD treatments that are done outside of India
- Pregnancy complications, miscarriages, etc.
- Except in the event of post-bite therapy, such as a dog bite, vaccination includes inoculation and immunization.
- Infertility, sterility, and other related conditions
- Dental treatment or dental surgery
List of Banks Providing Health Insurance Plans with OPD Cover
Below is a list of banks that provides health insurance plans with OPD cover -
OPD Health Insurance Plan | Sum Insured (Rs.) | OPD Cover |
Bajaj Allianz Tax Gain | NA | A single coverage covers all OPD hospitalization charges |
Aditya Birla Activ Health Enhanced Platinum Plan | Rs.2 lakh to Rs.2 crores | Rs.5,000 to Rs.20,000 |
Bharti AXA Health AdvantEdge | Rs.2 lakh to Rs.3 crores | Optional OPD cover |
Care Family Health Insurance Plan | Rs.3 lakh to Rs.6 lakh | Rs.5,000 to Rs.50,000 (Optional OPD cover) |
SBI Arogya Plus Plan | Rs.1 lakh to Rs.3 lakh | Treatment cover/OPD consultation |
Cholamandalam Family Healthline Plan | Rs.2 lakh to Rs.15 lakh | NA |
OPD Cover Claim Settlement Process
In order to claim settlement, you have to submit all the hospital bills and related documents after the completion of OPD treatment to your health insurance provider.
OPD Eligibility Criteria
The eligibility criteria for OPD health insurance coverage are mentioned below -
- People between the ages of 25 and 40 who may not use in-patient hospitalization as much as out-patient care.
- Senior citizens who require minor operations like cataract operation.
List of OPD Health Coverage Benefits
The various benefits of OPD health coverage are mentioned below -
- It is beneficial for individuals who require frequent hospital visits for OPD consultations, for root canal, viral fever, etc.
- People with existing medical issues can benefit from OPD as they require frequent medical visitation.
- People with chronic medical illnesses such as diabetes, thyroid disease, asthma, arthritis, and others who require regular doctor consultations can benefit from OPD coverage.
- Those who have an immunocompromised system will also benefit from OPD.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.
FAQs on OPD Treatment
- Can I purchase an insurance policy that solely covers OPD treatment?
It is determined by the insurance provider and the policies they provide. You should compare the policies before purchasing one that solely covers OPD treatment.
- Can I claim tax breaks for health insurance policies that include OPD coverage?
Yes, under Section 80D of the Income Tax Act, you can claim tax benefits on health insurance with OPD coverage.
- How can I obtain health insurance that includes OPD coverage?
OPD coverage is available as an add-on benefit in health insurance for a fee. It may, however, differ between insurance firms. Some plans, for example, include OPD coverage, while others offer it as an add-on. As a result, it's a good idea to double-check the coverage details so you can make an informed selection.
- What does cashless OPD mean?
The term "cashless OPD" refers to coverage for doctor consultation fees, dental treatment, diagnostic testing, eye care, medications, and so on. All of these costs are rising due to medical inflation, therefore having a health insurance plan that covers outpatient consultations is extremely useful, especially during the continuing COVID-19 pandemic.
- When am I allowed to use my OPD coverage?
The OPD coverage in your health insurance plan can be used for minor procedures or treatments that do not require hospitalization.
- What does OPD coverage in health insurance entail?
Outpatient Department treatment, abbreviated as OPD, refers to doctor visits required for medical treatments and diagnosis as prescribed. OPD visits can take place at a clinic or a hospital. The sole distinction is that OPD treatments do not necessitate hospitalization.
- Will cataract operation be considered as an outpatient procedure?
Yes, cataract operation is considered as an outpatient procedure.
- What is the OPD spending limit under health insurance?
The OPD limit is typically defined in policy wordings and is a portion of the sum insured. Any OPD claims or reimbursements are deducted from the total sum insured.
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