Not all diseases require hospitalization. There are certain ailments for which treatments only require consultations, diagnosis and any treatments without a stay in the hospital. The 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 hospitalization. In short, medical insurance with OPD covers include expenses incurred outside of in-hospital treatment.
Purchasing health insurance that covers OPD expenses is necessary for the following reasons:
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.
Outpatient department costs account for 62% of total healthcare costs. So, a cover against these medical expenses is beneficial.
Given below are the category of people who should invest in an OPD health insurance policy:
The specific benefits of this plan are as follows:
When you purchase an insurance plan including an outpatient expense cover, you get extra protection that provides financial coverage against daily medical expenses.
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.
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.
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.
With this cover, you can claim your expenses multiple times.
Your pharmacy bills will get covered under such a health insurance plan. This means if you purchase medicines, you can get the same reimbursed.
Expenses such as crutches, spectacles, contact lenses, hearing aid, and many others get covered under such a health scheme.
Certain insurance service providers allow you to carry forward a fixed portion of an unutilized sum insured amount in a specific policy period.
There is no specific eligibility norm when it comes to availing 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 utilize the benefits.
Following are the expenses covered under an outpatient department cover:
The differences between day care treatment and OPD are given below:
|Day Care Treatment||OPD|
|Day care treatments require hospitalisation, i.e., the patient has to stay at the hospital for a few hours||One doesn’t have to get hospitalised for OPD treatments|
|Many insurance companies cover day care treatments||Insurance policies don’t generally cover OPD treatments but one can opt for OPD health insurance policies|
|An example would be Lasik cataract procedures||Examples would include consulting a doctor for a vital fever or root canal treatment|
Find all the exclusions as listed below:
The important types of claim settlement process under OPD cover are detailed as follows:
1. Steps to follow for Cashless Claims:
2. Steps to follow for Reimbursement Claims:
The table given below provides the differences between OPD and In-patient Department treatments:
|OPD Treatment||IPD Treatment|
|Patient does not have to get hospitalised||Patient gets hospitalised for more than 24 hours|
|It involves the initial or subsequent medical consultations where the doctor checks, diagnoses and sets a treatment plan||After the consultations, if the doctor feels that the patient requires hospitalisation, he/she recommends IPD treatment|
|Examples would include medical consultations, ophthalmic procedures, minor surgeries||Examples would include gall-bladder operation, childbirth, rehabilitation|
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: It varies from one insurance provider to another. Many insurance companies have set the OPD coverage amount at a specified limit. People should check the specified OPD expenses for each medical insurance policy before selecting the one which is most suitable for them.
Ans: Daycare treatment and OPD expenses are considered different. So, daycare treatments do not fall under OPD cover. Importantly, daycare treatments are covered by most health insurance policies. But it is not the same with OPD expenses. This is the reason why it is advisable to opt for OPD health insurance policies.
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 an OPD expenses is about 90 days.
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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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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