Health Insurance with OPD Cover – Know the benefits and importance of OPD


6 min read

Tired of spending OPD costs on every hospital visit? Now invest in one of these top 5 medical plans that provide the OPD expenses cover benefit as well.

Not every visit to the hospital requires admission for treatment or hospitalization. Some hospital visits are limited only to the OPD meaning the Outpatient Department. This department in the hospital takes care of patient cases that are less critical and do not require urgent medical attention as in the case of an emergency.

However, truth be told, the expenses incurred in OPD hospital visits can be quite an amount and sometimes even burn a hole in the pocket of the bearer. This can be due to the higher frequency of visits required to the OPD, meaning the patient is called multiple times for doctor consultations, diagnosis, running diagnostic tests, taking X-rays, or for undertaking other procedures carried out at the OPD.

To help patients reduce the financial burden of bearing OPD costs, some benefits of health insurance with OPD Cover. Let us look at at least 5 of such plans that can provide financial relief to the patient and their family during difficult times.

Visual Stories by PayBima

What is OPD in a Hospital?

Before we talk about health insurance with OPD cover, let us begin by understanding in brief what OPD means in a hospital setting.

OPD is the abbreviated form of Outpatient Department. As is evident by the name, Outpatient is the exact opposite of Inpatient Department where those patients who are admitted into the hospital for treatment (brief or longer) can be found. As against this, the Outpatient Department or the OPD is where those patients come who simply need doctor consultations upon visit for a diagnosis of their respective health conditions.

The OPD patients consult the resident or consulting doctor available and pay consultation fees for the same. The OPD medical department is therefore responsible for overseeing appropriate medical assistance to all patients who visit the hospital for the first diagnosis of the condition. Upon diagnosis and prescription of treatment, some patients are then guided towards the IP department for admission for critical care.

Also Read: Difference Between Day Care Treatment And OPD Treatment

What is health insurance with OPD cover?

We learned above the exact OPD meaning and what the OPD department of the hospital takes care of. Now, what does OPD stand for in the context of health insurance? Let us understand below.

We already discussed earlier that OPD stands for Outpatient Department and that it is responsible for providing the basic care and assistance to a patient when they first come to the hospital. Now all the patients who visit the OP department of a hospital are required to pay a certain consultation fee or charge for seeking consultation with a specific doctor or specialist. All these charges are collected by the OP department of the hospital.

The cost of bearing these OPD expenses can sometimes be quite a bit, depending on the number of times the visits are required. This is where the OPD cover benefit of health insurance comes as a huge relief.

What is Health Insurance with OPD Cover?

We learned the meaning of OPD in the specific context of health insurance above. Now let us briefly understand health insurance with OPD cover.

Some health insurance plans provide an additional OPD cover benefit to their policyholders, meaning the latter can now claim coverage for certain non-emergency, less-critical health conditions as well. This is particularly helpful considering that most health conditions that require medical attention can be non-urgent and non-risky as well. In this case, a simple visit to the doctor’s clinic for consultation or diagnosis can invite a certain amount of expense.

This would include the doctor’s consultation fee in addition to the cost of running diagnostic tests, scans, or X-rays (if so required), not to forget, the cost of buying medicines from the pharmacy for the condition diagnosed. These costs sure add up and can sometimes mean a huge burden to the patient and his/her family.

Now, imagine a mediclaim policy that comes with the inclusive benefit of OPD cost cover! This would mean a significant portion of your healthcare expenses being completely covered by the insurer! Of course, OPD insurance comes with a wide array of benefits which we’ll discuss in the next section.

Health Insurance with OPD benefits: Benefits of health insurance with OPD cover

Some of the major benefits of availing this cover include:

  • Coverage of regular medical bills, particularly of the pharmacy (in case you tend to buy a monthly supply of medicines)
  • Coverage for non-emergency medical visits to the hospital (those that do not require hospitalization), which can be quite a few in a year
  • Coverage for regular doctor consultations and health check-ups at the hospital
  • Extra coverage over and above hospitalization expenses
  • Tax benefits on premiums
  • Flexibility to claim reimbursement of medical bills more than once to cover healthcare costs as and when they arise

Know More: Difference Between OPD and IPD Treatment

5 Best Health Insurance Plans with OPD Expenses Coverage Benefits

We discussed above the key benefits of buying OPD insurance cover. If you’re considering investing in one of these, here are the top 5 plans that are worth putting your money in:

Name of the Insurer Health Insurance Plan with OPD Expenses Coverage Minimum Sum Insured Plan Benefits Claim Settlement Ratio of Insurer
Max Bupa Heartbeat Rs. 15 lakh Global coverage, no capping on room rent, maternity cover, OPD treatment costs reimbursed, alternate treatments like Unani, Ayurveda, etc. also covered 89.46%
Manipal Cigna Lifetime Health Up to Rs. 3 crore Domestic and international coverage both, no room rent capping in global coverage, also covers hospitalization cost in India, unlimited restoration of sum insured for unrelated health conditions 91%
Aditya Birla Activ Health Enhanced Plan Between Rs. 2 lakh and Rs. 2 crore Benefits of health insurance, chronic care, and wellness benefits all included in one single plan, cost for modern treatments covered, like oral chemotherapy, robotic surgery, etc. 94%
SBI Arogya Plus Plan Up to Rs. 1 lakh, 2 lakh, and 3 lakh OPD cover for the whole family, also included multiple other covers such as Mental Illness Cover, HIV/AIDS Cover, and Genetic Disorder Cover 96%
Bharti AXA Health AdvantEdge Rs. 2 lakh; up to Rs. 3 crore OPD cover for newborn vaccinations in the first year after birth, dental treatments, air ambulance within country, domiciliary hospitalization, and wellness benefits 90%

Also Read: Health Insurance Plans with OPD Expenses Coverage Benefits


Health insurance with OPD cover is a highly useful insurance product as it provides coverage for regular costs arising from frequent hospital visits at the OPD or for high pharmacy bills. To know more about the best OPD health insurance in India, check out PayBima that gives detailed information on the top and leading insurers offering health insurance benefits in India.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.


View this post on Instagram


A post shared by paybima (@paybima)

FAQs on Health Insurance with OPD Cover Benefits

Which plan covers OPD treatment in Tata AIG?

Tata AIG Medicare Premier is designed to provide coverage for OPD dental treatments and procedures, high-end diagnostic tests, and emergency air ambulance services.

Is OPD covered in HDFC Ergo?

The HDFC Ergo OPD cover provides cost coverage for all OPD treatment procedures and expenses incurred.

Does OPD include dental?

Some health insurance companies offer OPD covers that include treatment for dental problems up to a certain limit specified in the plan.

What type of patients are received by the OPD?

The OPD of a hospital provides assistance to such patients who do not necessarily require hospitalization or a hospital bed for stay overnight. These patients visit the external facilities at the hospital such as diagnostic tests center or doctor’s clinic for the first-level diagnosis and treatment of the condition.

What is cashless OPD?

Some health insurance plans include cashless OPD cover benefit, which means that the cost incurred on OPD procedures and treatments such as doctor consultation, buying medicines from pharmacy, or running diagnostic tests at the lab are all covered under the policy.

Dec 10, 2022
Author Bio
Author Image


Related Blogs

Would love to hear from you

Share your candid feedback. Your email address won’t be published, we promise!

All fields are required

Find your suitable insurance plan

Speak to our advisor

Latest Posts

Mahindra Insurance Brokers Limited (A Mahindra Group Company) - Unit-202, A-Wing, 2nd Floor, Amiti Building, Agastya Corporate Park, Kamani Junction, LBS Marg, Kurla West, Mumbai - 400070. Tel: +91 22 66423800

Licenced by IRDAI License No. 261; License Validity : 17-05-2025; Category : Composite Broker; CIN : U65990MH1987PLCO42609 Member of Insurance Brokers Association of India (IBAI).

Insurance is the subject matter of solicitation.

For a seamless experience, use the latest version of Chrome/Firefox/Internet Explorer.

Copyright © 2024 Mahindra Insurance Brokers. All Right Reserved.

Get A Call Back
Get A Call Back