Seeking treatment for a disease or an accident may require hospitalisation, with your health insurance covering the expenses. However, OPD (Outpatient Department) charges are also to be accounted for, which entail high medical costs. According to a Financial Express report, these charges make up to 60% of all healthcare expenses. So, if these do not figure in your health insurance policy, you would essentially pay out a big chunk for your treatment from your pocket. But modern policies, thankfully, do take care of the OPD charges. It would be helpful to know all these expenses and choose a policy wisely, based on whether it is integrated into your plan or you need to buy it as an add-on or rider.
All About OPD
OPD does not require hospitalisation for more than 24 hours. The coverage includes, among other things:
- Visits to the doctor for consultation
- Medication
- Diagnostic tests
- Show test reports
- Regular checkups for chronic diseases
- Follow-up after hospitalisation
The insured may file a claim for expenses up to a specific limit for these medical appointments, as mentioned in the health insurance policy document. These charges include consultations with general physicians, dentists, paediatricians, specialists, orthopaedics, or any specialist the policyholder needs to meet. The rising medical costs make these exorbitant and add to the financial burden. However, you can compare health insurance and check whether those include OPD insurance coverage in their basic plans. If they don’t, it may be available as a rider.
Why are Insurers Proactively Providing OPD Coverage?
The core values of new-age insurance revolve around being proactive in providing customers with access to financial security in their time of need and taking precautions. The increasing competition in the industry ensures that insurers are upping their ante in providing the most beneficial plans. They offer it as an add-on cover that includes both physical and teleconsultations. Policyholders can use this coverage to consult doctors virtually, no matter where they are.
The Importance of OPD
By and large, here’s why an OPD visit is so important:
The First Step to Medical Care
Irrespective of the severity of the condition, a common cold or a headache that won’t go away and could be a migraine, the first OPD appointment is the initial step in medical treatment. Since this could, unfortunately, mean repeated visits to the physician or further intervention, OPD coverage will prepare you for it financially.
Makes the Crucial Early Diagnosis Possible
Early diagnosis is imperative for treating any condition. An OPD visit sets the groundwork for upcoming medical procedures for the same. It’s the foundation for the course of treatment that’s to follow, including diagnostic tests.
Access to Quality Medical Care
You can obtain the best available medical advice and consultation with experts and specialists with an OPD covered in your health insurance without worrying about the expense. It will give you the necessary financial support even for basic medical expenses such as minor surgeries.
Comprehensive Health Insurance
Even though OPD treatments are less costly than inpatient ones, the expense can be significant. With an OPD cover, you can get complete health insurance coverage.
Coverage for Injuries Due to Accidents
An OPD coverage takes care of the treatment cost for accidental injuries.
Coverage for Frequent OPD visits
If you have a pre-existing disease or a chronic condition that requires frequent visits to the hospital but not hospitalisation, then an OPD cover can be of great assistance for you.
Common Exclusions
Do note that health insurance with OPD coverage plans differs from one another. One insurer may provide something that others don’t. Usually, policies with OPD coverage have similar exclusions as regular health insurance plans. These broadly include treatment costs for:
- Injuries due to illegal activity
- Substance abuse of any kind
- Daycare or hospitalisation for AYUSH treatment
- Cosmetic surgery
- Self-inflicted injuries
Every policy will have its own set of inclusions, exclusions, and terms and conditions.
Top Health Insurance Policies with OPD Cover in 2022
Many reputable companies provide health insurance with OPD coverage in India. Some of the top plans this year are:
ICICI Lombard Complete Health Insurance
The USP of this family floater health insurance is no limit on hospital room rent, no co-payment, no health check-up before 45 years of age, and two free health check-up coupons a year.
Apollo Munich Maxima
Along with OPD insurance coverage for daycare costs, this plan offers inpatient treatment, pre and post-hospitalisation costs, maternity expenses and more.
Bajaj Allianz Tax Gain Plan
A policyholder can use personalised services for senior citizens, ambulance cover, and co-payment waiver, with affordable premiums starting from INR 5,000.
Aditya Birla Activ Health Enhanced Plan
The unique policy offers health insurance, wellness benefits, and chronic care, all rolled into one policy. Coverage for the latest treatments, such as robotic surgeries, oral chemotherapy, and mental illnesses.
Bharti AXA Health AdvantEdge
The sum insured in this policy starts from INR 2 lakh and goes up to INR 3 crore. You can get coverage for dental treatments, vaccination for a newborn in the first year, domestic air ambulance, domiciliary hospitalisation and more.
Care Health Insurance Plan
The sum insured, which includes OPD coverage, starts from INR 5 lakh and goes up to INR 6 crore. Care health insurance plan provides OPD as an optional cover that you can health insurance claim equivalent to the amount of medical bills during reimbursement.
Conclusion
Many treatments do not require hospitalisation, but even a simple doctor’s consultation for diagnosis or follow-up can raise the medical bills substantially. Instead of paying this yourself, most health insurance plans include OPD coverage to support requirements such as a cast on a fracture, diagnostic tests, checkups, medication, and more. Before buying health insurance, read the characteristics and coverage of the OPD plans in detail.
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