- Avail coverage for outpatient treatments
- Explore the eligibility criteria
- Difference b/w OPD & Day Care Treatment
Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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Anchita has over 6 years of experience in content marketing, insurance, and healthcare sectors. Her motto to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
Updated on Apr 08, 2025 2 min read
What is OPD Coverage in Health Insurance?
Sometimes, we go to the hospital and come back home after getting medical treatment within a few hours. This procedure is known as OPD in medical terminology. OPD stands for Outpatient Department. You can find different sections like Neurology, Orthopaedics, Gynaecology, and much more under OPD. Therefore, coverage for OPD provides expenses such as doctor’s consultation fees, pharmacy bills, health check-ups, and diagnostic tests.
In comparison to other health insurance policies the sum insured under the OPD coverage is determined by your age. Let us understand more about OPD coverage in health insurance below.
What are the benefits of Health Insurance for OPD Coverage?
Manages Expenses
Outpatient care can add up quickly, especially when you need to visit a doctor frequently, and need to undergo tests and medications. The coverage for OPD helps you manage these costs by reimbursing you for the covered expenses.Encourages Preventive Care
There are many OPD plans that cover preventive checkups and screenings. This way you can identify any potential health issue at an early stage, when they are often easier and less expensive to treat.lexibility and Convenience
You can seek medical attention without worrying about the cost. This allows greater flexibility in scheduling appointments and receiving treatment.Broader Coverage
Some of the OPD plans offer coverage for a wider range of services, including consultations with specialists, alternative therapies, and even dental and vision care. This way you will get a comprehensive safety net for your healthcare needs.Reduced Financial Stress
Knowing you have OPD coverage can give you peace of mind, reducing the stress of unexpected medical bills. This way you can focus on other important things in life.
Health Insurance Plans With Opd Cover in 2024
| OPD Health Insurance Plans | Sum Insured | Entry Age |
|---|---|---|
| Care Plus | Upto INR 5 Lakh | 18 years and above |
| Niva Bupa ReAssure 2.0 | Upto INR 1 Crore | 18 years and above |
| Niva Bupa Aspire | Upto INR 1 Crore | 18 years and above |
| Star Comprehensive | Upto INR 1 Crore | 3 months to 65 years |
| Aditya Birla Activ Health Platinum Enhanced | Upto INR 2 Crore | 5 years |
How is OPD Different from Day Care Treatment?
People often get confused in OPD Daycare treatments. Before buying any policy, do understand how one is different from the another. Take a look at the below given comparison to get a clear picture about the two:
| Parameters | Day-care Treatments | OPD Treatments |
| Hospitalization Type | Under day-care treatments, the patient is required to stay in the hospital for a few hours. | OPD treatments do not require any hospitalization. Patients can come, consult the doctor and can go. |
| Waiting Periods | Generally comes with a waiting of three years, which means treatment can be availed only after serving the waiting period except for any accidental injury. | It comes with a waiting period of 90 days. |
| Sub-limits | There are no sub-limits. Treatment costs are covered up to the chosen sum insured. | Comes with a sub-limit of your overall sum insured limit. |
| Treatments Covered |
|
|
What are the Eligibility Criteria for OPD Coverage?
There are is no specific eligibility criteria to avail of OPD benefits. Any individual who is feeling unwell can go to a doctor’s clinic for consultation and treatment.
*However, the possibility is that your health insurance company may have some sort of eligibility criteria or waiting period for OPD coverage. Therefore get in touch with your health insurance provider to understand the criteria.
Who Should Buy Health Insurance with OPD Coverage?
Immuno-Compromised People
Having a health insurance with OPD Cover is useful for those, whose immune system is weak and they require frequent hospital visits for OPD consultations including something as basic as viral fever.
Also, medical insurance with OPD cover is beneficial for those patients who have pre-existing medical conditions such as thyroid, diabetes etc. and require frequent medical consultations.Sports Enthusiasts
If you are someone who likes to engage in physical activities or are a sports person, then you must go for a health plan that offers OPD cover. This is because while indulging in any sort of sports or fitness activities, people are very much prone to injuries that may not require hospitalization, this is why having a health plan with OPD cover will save you from such expenses.Senior Citizens
Senior citizens are more prone to health ailments and are usually more likely to require OPD treatments like dental treatments and minor surgeries. Thus, it is of utmost importance for them to consider taking a health plan with an OPD cover which will help cover both regular health insurance benefits and OPD treatments. Having a health insurance which covers OPD expenses will save them from broadening their pockets during doctor’s visits.Working Professionals with Limited Group Medical Insurance Coverage
Most companies offer group medical insurance to their employees. However, usually, the coverage is low and people often prefer to buy another health policy for better protection. In such cases, one can go with an additional health insurance policy with an OPD cover since a lot of group medical insurance plans don’t include OPD benefits.
Know what is Covered- Inclusions
- Cover for Doctor’s fee
- Diagnostic expenses cover
- Medicine bills cover
- Regular OPD Visits
- Tax Deductible
- OPD treatments
- Hearing aid
- Minor surgeries
- Dental treatment
What is not Covered?- Exclusions
- Treatments for beautification, purification such as plastic surgeries, etc.
- Any claim resulting due to involvement in illegal activities.
- Any claim resulting due to substance abuse.
- Investigational treatments or experiments.
- Inpatient treatment, daycare procedures, and naturopathy treatments.
- Treatments related to Sterility, infertility, and other related conditions.
- Self-inflicted injuries.
- International OPD treatments availed
- Any treatment related to fertility medical issues
- Pregnancy/Miscarriages
- Treatments for rejuvenation/wellness
Conclusion
There are several illnesses that can be treated only by the medicines prescribed by doctors. Sometimes, these doctor’s consultations may continue for a longer period, often burdening your pockets. Thus, before buying a health plan, make sure that the OPD is covered under the same, and get your consultations, diagnoses, and treatments covered under a health plan.
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What is OPD Cover?: FAQs
1. Why should I get health insurance with an OPD cover?
With a continuous increase in the healthcare facilities, a normal doctor consultation from a private hospital can cost somewhere between Rs.700- 1000. This means for a normal viral fever, you will have to spend almost 4-5k which will include all the tests & consultations. To protect you from such expenses, it is better to have health insurance with an OPD cover.
2. Is there any limit to avail OPD benefit under a medical insurance with OPD cover?
Yes, the OPD treatments come with a sub-limit. Go through the policy wordings carefully to know the OPD limit of your policy.
3. How can I buy an OPD health plan?
Get in touch with the experts at PolicyX.com. They will help and assist you with all your queries.
4. What is the difference between OPD health insurance and daycare treatments?
Both are part of a health insurance plan however they are technically different as Day care treatments require hospitalization for not more than 24 hours while for an OPD treatment, you do not require hospitalization at all.
5. Are OPD health insurance eligible for tax benefits?
Yes, OPD cover health insurance plans are eligible for tax deductions under the Income Tax Act.
6. When can an insurance holder utilize OPD health insurance?
Insurance holders can utilize OPD health insurance when they do not require hospitalization, or if they have undergone surgery or major treatment and want to go for follow-ups and health check-ups.
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Written By: Simran Saxena
Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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