Why you should opt for OPD in Health Insurance?

Important pointers for a hassle-free OPD in health insurance, read on.

Need for OPD in Health Insurance Grows Post Covid Scenario

With medical tests and treatment costs of simple OPD procedures increasing, OPD health insurance along with standard medical insurance is the need of the hour.

An incident like an accident or sudden visit to a doctor due to fever or other illnesses could happen at any time. Minor accidents could be anything from a sprained ankle, a broken leg, or multiple stitches. The costs for these medical services or OPD charges as they are known are not small in any way. Due to the pandemic scenario non-hospitalisation or medical attention without hospitalisation are also more frequent. During accidents, a dressing for a fracture could cost anything between Rs. 5000 to 10,000 depending on the hospital or clinic one decides to visit. Nowadays to avert the risk of Corona, people are getting the tests done at home which is covered under OPD Health Insurance. Well, OPD insurance is the way forward in these difficult times. OPD in health insurance is equally important along with health insurance as a matter of fact.

Having said that, it is important to note that many youngsters do not think or worry about having to visit a doctor for a standard check-up. The reason is they plan a low budget for medical in general and sign up for a low sum insured. Here the OPD is completely avoided and at times never considered. Nowadays the costs for various tests, consultations, and standard nursing like attending to a sprain or minor surgery are extremely high. This too can be covered under OPD or Outpatient-department and save crucial resources to be able to endure crunch times. Under this additional OPD cover, the insured would get coverage for minor treatments, bandages, consultation fees, X-rays etc. 

What comes under OPD in medical health Insurance?

 Most health insurances provide a separate OPD coverage which is included if requested. Informing that at the time of signing up for the insurance provides one with the benefits of day-care treatments, that don’t require hospitalisation to make a claim. The following 4 major services are covered under OPD health insurance. 

  • Consultation fees for doctors: having to visit doctors for consultations these days in the backdrop of seasonal diseases, the fees are covered under OPD expenses. The check-up done by a doctor for any disease or illness is covered by OPD in health insurance.
  • Standard medication along with diagnostic fees: Most illnesses require confirmation and that includes all recommended test procedures by the doctor. X-rays, blood tests, scans done by various diagnostic centers, etc are also included under this cover. This also includes tablets, syrups, and other prescribed medicines which also cost quite a sum. 
  • Minor surgeries: Pelvic organ prolapse or POP operation, suture procedure or stitches or standard bandaging or dressing for minor accidents, and animal bites are all covered under OPD.
  • Fractures or sprains: these procedures also fall under OPD as they don’t require hospitalisation but they do need the consultation and supervision of a medical practitioner. 

Why you should take an OPD cover with your health insurance?

When health insurance is bought, make sure OPD coverage is also taken along with it, just so that all non-hospitalisation medical assistance if required is covered. With Corona never-ending and some insurers providing coverage for their tests even when they are being conducted at home is now a reality. It is noteworthy and is the requirement of the times, that insurance services have been designed to suit the needs of the insured. 

  • The biggest benefit is no hospitalisation is required to initiate a claim. So various minor surgeries, fractures, dental treatments, and stitches etc are covered under OPD claims.
  • It has been noticed that medical expenses are still increasing even though there is no hospitalisation. In other words, visits by the local doctor have increased, as people don’t want to go personally to a clinic or specialty hospital due to Covid. A doctor’s visit is covered under OPD expenses. Therefore, just simply budgeting for a comprehensive medical plan might just not be enough. There is a need to factor in OPD expenses as well. 
  • Till the limit of the annual OPD coverage is not exhausted, one can make multiple claims for consultation or doctor’s visits, or standard nursing procedures like stitches, dressing, and minor surgeries. This is also to cover for consultations regarding seasonal diseases. 
  • Covid tests at home are also included by certain new OPD insurers. You can make sure this is included by requesting for it.

Read Also Demands on health insurance in the post covid scenario

Difference between OPD and day-care procedures

Day-care procedures require hospital admission while in OPD hospitalisation is not required at all. OPD covers all doctor consultations, tests, cost of medicines prescribed by a medical practitioner, sutures, bandages, X-rays, etc. While in a day-care procedure a patient is to be admitted to the hospital but for less than 24 hours for services related to minor surgeries or other treatments like dental, POP operation etc.

Most people tend to overlook OPD expenses, however, if multiple doctor visits or consultations over a period of one year are calculated it could be quite a sum. The norm nowadays is to get an OPD in Health Insurance to cover those overlooked, yet frequent medical expenses.

Tip: Many OPD insurers give a discount of 7.5% on premium if insurance is bought online.

Types of OPD Cover in Health Insurance:

  • Niva Bupa OPD Health Cover @ approx Rs. 772 per month
  • Star Health OPD Health cover @ approx. Rs. 689 per month
  • Aditya Birla OPD Health cover @ approx. Rs. 1089 per month
  • Tata AIG OPD Health Cover @ approx. Rs. 822 per month


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