As we know, inpatient medical expenses are more compared to outpatient expenses. But according to a recent study by ET Prime, outpatient department (OPD) expense account for roughly 62% of all healthcare costs in India. Considering the rising healthcare costs, a health insurance plan with OPD coverage is a good option. Reading this article, you can learn more about OPD coverage in health insurance.
What is OPD in Health Insurance?
OPD in health insurance is when patients need optimum medical attention. The policyholder will be financially protected from any OPD-related treatment and consultation costs without hospitalization. You must visit the doctor's clinic and pay the consultation fees to receive OPD treatment. In the case of a hospital, patients receive medical assistance and support in the general OPD ward.
Every health insurance company offers those types of health insurance plans that cover OPD treatments. The OPD cover offers coverage for expenses not covered in in-patient hospitalization.
Benefits of OPD Cover in Health Insurance Plans
Below mentioned are some of the benefits of OPD coverage in health insurance plans:
- OPD cover helps you to claim medical expenses that were incurred without hospitalization.
- OPD cover offers coverage for diagnostics charges, doctor's consultation fees, and pharmacy bills.
- OPD cover is a must for those who need regular OPD visits.
- OPD cover helps you in tax savings.
Eligibility Criteria for OPD Cover
There are no specific eligibility criteria for OPD coverage, and the criteria for OPD coverage are based on the health insurance plan you purchased. If your health insurance plan covers OPD expenses, you can avail of all its benefits.
Inclusion of OPD Cover in Health Insurance
Below mentioned are the inclusions of OPD coverage in health insurance:
- Doctor consultations
- OPD treatment
- Dental Treatment
- Pharmacy expenses
- Diagnostic tests
Exclusion Under OPD Cover in Health Insurance
Below mentioned are the exclusions of OPD coverage in health insurance.
- Treatments related to purification, beautification, panchakarma, detoxification, etc.
- The expense of lenses, spectacles, hearing aids, implants, prosthetic devices, braces, etc.
- Treatment outside the country.
- Preventive health check-ups.
- Investigational experiments.
- Investigational treatments.
- Infertility and sterility-related conditions.
- Complications arise due to pregnancy, miscarriage, etc.
OPD Treatment vs Daycare Treatment
Daycare treatment and OPD treatment are similar to each other. But there is a slight difference between the two as they differ in technical aspects. Following are the differences between the two types of treatment:
Day Care Treatment
Requires hospitalization of less than one day.
Does not require hospitalization.
Settlement of claims will only be honoured if hospitalization is at most 24 hours.
Settlement of claims will be honoured only for non-hospitalization.
Out Patient Treatment vs In-patient Treatment
Outpatient treatments and in-patient treatments are different from each other. Below mentioned is the difference between OPD and IPD treatments:
Out Patient Treatment
In Patient Treatment
No need to admit to the hospital
Need to admit to the hospital.
Does not require hospitalization.
Requires hospitalization for more than 1 Day.
Reasons To Buy a Health Insurance Plan with OPD Cover
A health insurance plan with OPD cover is very beneficial for anyone. A recent study shows doctors' consultations and other OPD treatments are increasing yearly. So, below we have mentioned those who should buy a health insurance plan with OPD coverage:
- People lie in the age group of 25 to 40 years.
- Senior Citizens
- Retired Persons
- Fitness Enthusiastic
Buying Process of Health Insurance with OPD Cover
Below mentioned is the buying process for health insurance with OPD cover:
- Visit the official website of your desired health insurance company
- Select the desired health insurance
- Enter the required information
- Click on the "Proceed" button
- The next page will show you the available add-ons. You can select any of them to enhance your coverage benefits
- Now, you will get the premium amount that you have to pay for a health plan with OPD coverage
- Make the payment online
- The health insurance company will send the policy document to your registered email address.