Top Health Insurance Plans with OPD Expenses Coverage Benefits


5 min read

A new health insurance benefit that goes beyond providing coverage for only hospitalization but covers day-to-day OPD expenses as well. Read more about the best OPD health insurance in India cover in this blog.

In times when healthcare costs are ever skyrocketing, health insurance definitely comes as a boon. It is only through insurance that one can even hope of sailing through the financial strain resulting from a medical emergency. However, health insurance has conventionally been known to provide financial coverage only for expenditure on hospitalization. Now, such situations are rare, however, financially stressful. The more common occurrences can be seen in Out Patient Department (OPD) visits, the expenses of which were generally not covered under insurance until now.

With the new health insurance with OPD coverage benefits introduced by most health insurance providers, policyholders can heave a sigh of relief. A number of small but considerably significant regular OPD expenditures can now be taken care of, releasing the financial load on your pocket to a slight extent. Let’s learn more about this new feature below.

Also Read: OPD and IPD full form

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What is Health Insurance with OPD Cover?

A number of health insurers have come up with a new and unique insurance cover feature known as health insurance with OPD cover. A few examples include Bajaj Allianz, Apollo Munich, Cigna TTK, and ICICI Lombard. This benefit has been designed keeping in mind that conventional health insurance plans fail to cover beyond the scope of hospitalization expenses for the insured.

This means that expenditure incurred on more regular OPD requirements such as doctor consultation fees, pharmacy bills, diagnostic tests, and the like, fail to be covered by health insurance plans with opd coverage. With the OPD insurance benefit, one can now avail insurance cover for OPD-related expenses as well.

6 Benefits of OPD Expenses Coverage Under Health Insurance

Here are some of the top advantages of the OPD cover for the policyholder:

  1. The prime benefit of health insurance with OPD cover is that all expenses related to the OPD, and not just the hospital stay, can now be claimed under your health insurance plan.
  2. A number of health insurance plans providing OPD cover allow the insured to raise more than one claim for OPD expense coverage during the entire policy tenure. This is because OPD expenses are generally incurred more times than those on hospitalization.
  3. The sum assured to the policyholder under the OPD cover is determined on the basis of their age, unlike in traditional health insurance plans where the sum assured is determined by minimum 24-hour hospitalization.
  4. Tax benefits are higher under health insurance plans with OPD coverage compared to regular mediclaim policies. For instance, the premium payable on the OPD cover is exempted from tax. Also, the claims made under this cover are free of Tax Deductible at Source (TDS).
  5. The OPD expenses cover provides financial coverage for pharmacy bills as well. This can be a huge relief to the insured since medicine costs can be quite a lot.
  6. Claims under the OPD cover can be raised within 90 days of buying the health insurance plan.

Read More: What Is The Importance Of A Health Insurance Policy In Our Life?

Other Health Insurance Companies

3 Best OPD Expense Coverage Health Insurance Plans in India

Now that we know the benefits of availing the OPD cover under health insurance, let us look at some of the best health insurance with OPD expense coverage plans:

1. Apollo Munich Maxima Plan

  • Insurer Company~ HDFC ERGO Health Insurance
  • Cover benefits: Cashless OPD expenditure at certain authorized pharmacies, diagnostic test labs, dental care facilities, optical eye centers, and the like, doctor consultation fee, health checkups for policyholders over 18 years of age, and maternity benefits, both pre- and post-delivery
  • Minimum entry age: 91 days
  • Maximum entry age: 65 years
  • Premium amount: Basis the age of the insured in case of individual plan; in case of family health insurance plan, the premium is determined based on the age of the eldest member insured
  • Non-Utilization of OPD cover: 50% of the cover benefit gets transferred to the next policy term in case the entire benefit was not availed during the current policy tenure

2. Bajaj Allianz Tax Gain Plan

  • Insurer Company~ Bajaj Allianz Health Insurance Company
  • Type of plan: Family floater covering both hospitalization and OPD expenditure
  • Cover benefits: Cashless facility at more than 5,000 network hospitals across India, quick claim filing and settlement, coverage provided for expenses incurred on spectacles, dentures and other dental treatments, crutches, and the like, and ambulance charges up to Rs. 1,000
  • Tax benefits: Section 80D of the ITA, 1961 offers several tax benefits on the premium payable towards the cover

3. Max Bupa Heartbeat Platinum Plan

  • Insurer Company~ Niva Bupa Health Insurance Company
  • Type of plan: Comprehensive; both individual and family floater plans available
  • Age of entry: No limit on minimum or maximum entry age
  • Minimum Sum Insured: Up to Rs. 15,00,000; OPD claims under the plan have a max limit up to Rs. 30,000
  • Cover benefits: Maternity benefits pre- and post-delivery, child care cover, vaccination cost for the first year of birth, financial cover for newborn, and the like
  • Non-Utilization of OPD cover: 80% of the cover benefit gets transferred to the next policy term in case the entire benefit was not availed during the current policy tenure
  • Premium amount: Basis the age of eldest member insured
  • Tax benefits: Section 80D of the ITA, 1961 offers several tax benefits on the premium payable towards the cover

Also Read: Top 10 claim settlement ratio health insurance companies in India


Hospital expenditures can put a heavy burden on one’s pocket and if these expenses need to be incurred more than once in a year, the load can be quite stressful. This is why health insurance plans offer hospitalization expenses to the insured. However, the need for hospitalization may be quite limited in the life of the policyholder. The more common expenses are incurred on OPD such as consultation with the doctor, taking diagnostic tests, and buying medicines from the pharmacy.

This is why the new feature of health insurance with OPD cover has been introduced, thereby releasing the load on the insured. To look for the health insurance plans with OPD cover in India, check out PayBima that provides details on the top health insurance plans providing the OPD cover benefit.

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Nov 09, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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