What is OPD Cover?
  • Avail coverage for outpatient treatments
  • Explore the eligibility criteria
  • Difference b/w OPD & Day Care Treatment
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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

Check Out the Plans Below

A flexible health plan that covers advanced technology methods, unlimited e-consultations and personal accidents.

Unique Benefits

  • 200% increase in cumulative bonus
  • Rewards for being fit
  • Dental and Ophthalmic cover

Care Plus (Pros)

  • Unlimited Recharge Benefit
  • High Sum Insured
  • Cover up to 6 family members
  • Up to 200% No Claim Bonus
  • 10% renewal discount

Care Plus (Cons)

  • Change of Gender Treatments
  • Obesity Treatment Unavailable
  • Hazardous Activity Not Covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Care Plus (Other Benefits)

  • 5% Digital Discounts
  • Annual health check-up
  • Unlimited e-consultations
  • Health Services Available
  • Air Ambulance Cover

Care Plus (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - Lifelong
  • SI - 3 L to 25 L
  • Waiting Period - 30 Days

This plan is designed for youngsters and allows the policyholder to go overseas for treatments.

Unique Features

  • Exclusive maternity benefits
  • Adoption is included
  • Borderless facilities

Niva Bupa Aspire Plan (Pros)

  • Overseas treatment coverage
  • Booster benefit
  • Covers organ donor transplant
  • Second medical opinion
  • Teleconsultation

Niva Bupa Aspire Plan (Cons)

  • No suicide cover
  • No war injury cover
  • Baby food & utility charges excluded
  • Laundry charges excluded
  • No certificate charges

Niva Bupa Aspire Plan (Other Benefits)

  • 4 unique variants of the plan
  • Cash-bag benefit
  • WellConsult OPD Wallet
  • Cashless claim settlement
  • AYUSH Treatment

Niva Bupa Aspire Plan (Eligibility Criteria)

  • Entry age - 18 years
  • Max entry age - No AgeLimit
  • SI - INR 3L to 1 Cr
  • Waiting Period - 30 days

Niva Bupa Reassure 2.0 provides insurance holders with a high sum insured through their platinum, titanium, and bronze variants along with a multitude of other features.

Unique Features

  • Booster+ Benefit
  • Lock premiums at entry age
  • Health check-ups from day 1

Health ReAssure 2.0 Plan (Pros)

  • Personal accidents covered
  • Acute Care
  • Emergency Ambulance
  • Three Plan variants
  • Home Care Treatments

Health ReAssure 2.0 Plan (Cons)

  • No OPD Cover
  • No Maternity Cover
  • No Sleep Disorder Covered
  • Pre-Existing Diseases after 3 yrs.
  • Alcoholism not covered

Health ReAssure 2.0 Plan (Other Benefits)

  • Air Ambulance
  • Modern Treatments
  • Second Opinion
  • Booster Benefit
  • Shared Accommodation Benefit

Health ReAssure 2.0 Plan (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - No Age Limit
  • SI - 5 L to 1 Cr
  • Waiting Period - 30 Days

This policy is designed to provide complete protection against all health care eventualities to you and your family.

Unique Features

  • Health check-ups for claim-free years
  • Hospital Cash Benefit
  • 100% Automatic Restoration

Activ Health Platinum Enhanced

A unique Plan with features such as a chronic management program, modern treatments, covid-19, and more.

Unique Benefits

  • High SI
  • Affordable Premiums
  • Wellness Benefits

Activ Health Platinum Enhanced (Pros)

  • Earn 100% Health Return
  • Cover for Dental Consultations
  • Modern Treatment Cover
  • Wellness Coach
  • Mental Illness Cover

Activ Health Platinum Enhanced (Cons)

  • Illness due to intoxicants
  • Change Of Gender Treatment
  • Hazardous Activity not covered
  • HIV/AIDS not covered
  • Cosmetic Surgery unavailable

Activ Health Platinum Enhanced (Other Benefits)

  • Chronic Management Program
  • Premium Waiver Benefit
  • Reload of SI
  • Road Ambulance Cover
  • Second e-opinion

Activ Health Platinum Enhanced (Eligibility Criteria)

  • Entry Age - Years
  • Max Entry Age - Years
  • SI - 1 L to 1 Cr
  • Waiting Period - 30 Days

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:

ParametersDay-care TreatmentsOPD Treatments
Hospitalization TypeUnder 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 PeriodsGenerally 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-limitsThere 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
  • Diagnostic tests & X-rays
  • Doctor's fees
  • Routine check-up, vaccination
  • Minor surgeries
  • Dental treatment.
  • Cataract operation
  • Nasal sinus aspiration
  • Glossectomy
  • Lithotripsy
  • Coronary angiography
  • Haemodialysis

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

Make Health Your Top Priority Banner

Complete Health Suraksha Banner

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.

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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