What is OPD Cover?
- Avail coverage for outpatient treatments
- Explore the eligibility criteria
- Difference b/w OPD & Day Care Treatment
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.
| 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 |
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 |
|
|
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.
Cover for Doctor's fee
Diagnostic expenses cover
Medicine bills cover
Regular OPD Visits
Tax Deductible
OPD treatments
Hearing aid
Minor surgeries
Dental treatment
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
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.
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.
Yes, the OPD treatments come with a sub-limit. Go through the policy wordings carefully to know the OPD limit of your policy.
Get in touch with the experts at PolicyX.com. They will help and assist you with all your queries.
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.
Yes, OPD cover health insurance plans are eligible for tax deductions under the Income Tax Act.
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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