Not all diseases require hospitalisation. There are certain ailments for which the treatment can only require consultations, diagnosis and treatments without a stay in the hospital. Outpatient Department or OPD includes all such treatment variables.
In India, various insurance companies offer OPD cover health insurance to policyholders as financial coverage against such types of treatments that do not require hospitalisation. In short, medical insurance with OPD covers includes expenses incurred outside of in-hospital treatment.
Purchasing health insurance that covers OPD expenses is necessary for the following reasons:
Increasing need
Our lifestyle and way of living is constantly evolving. This change has led to the prevalence of various illnesses and chronic ailments requiring long-term care. Thus, it is essential to purchase health insurance with OPD benefits. This cover will help to take care of regular medical expenses.
OPD costs contribute to most of the total healthcare costs
Outpatient department costs account for 62% of total healthcare costs. So, a cover against these medical expenses is beneficial.
The specific benefits of this plan are as follows:
Additional coverage
When you purchase an insurance plan including an outpatient expense cover, you get extra protection that provides financial coverage against daily medical expenses.
Cashless claim
Some insurers offer a cashless scheme to cover treatments undertaken at the outpatient department. This makes your claim process smooth and eases off cash crunches arising during medical treatments.
Sum insured
A sum insured amount gets determined based on the policyholder’s age for plans with OPD cover health insurance. In a floater policy, the eldest member’s age gets considered.
Greater tax reliefs
Health insurance plans covering OPD expenses provide greater tax exemption on the premium amount. In addition to this, there will be no tax deduction at the source for claims.
Multiple claims possible
With this cover, you can claim your expenses multiple times.
Pharmacy bills covered
Your pharmacy bills will get covered under such a health insurance plan. This means if you purchase medicines, you can get the same reimbursed.
Covers a wide variety of expenses
Expenses such as crutches, spectacles, contact lenses, hearing aid, and many others get covered under such a health scheme.
Carry forward benefit
Certain insurance service providers allow you to carry forward a fixed portion of an unutilised sum insured amount in a specific policy period.
There is no specific eligibility norm when it comes to availing of outpatient department benefits. Anyone unwell can visit their nearest clinic and avail of medical treatment. A policyholder can then claim expenses under this healthcare scheme.
If you are eligible to purchase a particular health insurance policy with an outpatient cover, you can utilise the benefits.
Following are the expenses covered under an outpatient department cover:
Find all the exclusions as listed below:
Follow these simple steps to purchase a health insurance policy with OPD cover:
Medical insurance with OPD cover helps boost the scope of coverage under insurance policies further. Through this scheme, policyholders can take care of their daily medical expenses, as mentioned above. With a growing rise in basic medical expenses such as consultation fees, diagnosis fees, and more, this healthcare policy can be extremely beneficial for any family.
To avail of an OPD cover under your health insurance policy, turn to Navi health insurance. Download the Navi App today to enjoy an instant paperless application process!
Ans: An outpatient department expense is included under the sum insured limit. Any outpatient expenses are deductible from your coverage amount.
Ans: The waiting period for claiming OPD expenses is about 90 days.
Ans: No, OPD care does not offer financial coverage for daycare treatments.
Ans: Yes, you can get tax relief under outpatient care.
Ans: Insurers usually offer this scheme under any specific health insurance plan as an add-on.
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