OPD or Outpatient Department is a cover offered under many health insurance policies. This cover pays the expenses incurred by the insured for outpatient treatment. However, not all health insurance plans offer OPD as an in-built feature under their basic health plans. It is usually available as an add-on coverage. It includes expenses for doctor consultation fee, bills incurred at chemist shops, routine health check-ups and diagnostic tests among others. Let us delve more into the OPD cover in health insurance in this post.
OPD is a cover offered under health insurance policies which pays for the expenses of outpatient treatment. This cover makes sure that your insurance company pays for the expenses incurred by you for OPD coverage without hospitalization. OPD may not be a permanent feature of most health insurance policies, however it can be availed as an add-on by policyholders.
Nevertheless, there are certain plans offered by some insurers who allow OPD coverage as an in-built feature along with their basic health insurance policies.
Health insurance plans with OPD cover offer numerous benefits:
Below are inclusions under OPD cover:
There are many people who get confused with OPD insurance and Day Care treatment. However, the fact is OPD and Day Care treatment are two different and dissimilar features.
Here are some differences between the two features of health insurance:
| Feature | OPD | Day Care |
| Hospitalisation | Treatment in the OPD does not require hospitalisation | Day Care treatment needs hospitalisation of less than 24 hours |
| Coverage scope | OPD cover is usually not offered as an inbuilt protection unless it is mentioned in the policy document | Day Care procedures are covered by most health insurance policies |
| Coverage level | OPD treatment is not covered up to the sum insured. It might come with a sub-limit | Day Care procedures are covered up to the sum insured without any coverage limit |
OPD cover should be included by everyone under their health insurance plan. It is especially recommended for the following people:
Below are the simple steps that can be followed to buy a health policy with OPD cover:
Here are some plans offered by different health insurance companies with OPD cover:
| OPD Health Plans | Sum Insured (INR) | Eligibility criteria | OPD Cover |
| Aditya Birla Activ Health Enhanced Platinum Plan | 2 lakh - 2 Crores | Min age limit 5 years (individual plan) Min. age limit 91 days (family floater plans) |
OPD Limit - INR 5000 to INR 20,000 |
| Care Family Health Insurance Plan | 3 lakh - 6 lakh | Min. entry age 91 days | Optional OPD Cover of INR 5,000 to INR 50,000 |
| Niva Bupa (Formerly known as Max Bupa) Go Activ Health Plan | 4 lakh - 25 lakh | N/A | Up to 10 cashless OPD consultations |
| Star Outpatient Care Health Insurance Plan | 25,000 - 1 Lakh | 1age limit - 8 to 50 years | OPD cover at all network facilities |
| SBI Arogya Plus Plan | 1 lakh - 3 lakh | Age limit 18 to 65 years | OPD consultation/treatment cover |
Depending on your health condition and your healthcare requirements, you may opt for OPD coverage to avail maximum protection. Senior citizens may look for policies with OPD coverage as they frequently visit the doctors on OPD.
OPD in the hospital is the Outpatient Department. OPD is a cover offered under health insurance policies which pays for the expenses of outpatient treatment.
Cashless OPD allows coverage against doctor’s consultation fee, diagnostic tests, medicines, etc. With the expenses of healthcare touching the sky, having a health insurance policy with OPD coverage is very beneficial.
The OPD limit is mentioned in the policy wording of your plan. Different insurers may have different policies regarding OPD deduction.
Yes, OPD health insurance can be bought online. Different health insurance companies are offering OPD cover with their basic health policies or as an add-on which can be availed online.
You can use your OPD coverage for minor treatments and procedures which can be taken care of by a doctor’s appointment and do not need hospitalization.
* Rs. 245/month is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*! Rs. 334/month is the starting price for a 10 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*@ Rs. 12/day is the starting price for a 5 lac family health insurance for an 25-year-old male and 22-year-old female, with no pre-existing diseases.
*# Rs. 12/day is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*$ Rs. 600/month is the starting price for a 20 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*^ Rs. 12/day is the starting price for a health insurance that covers coronavirus for an 25-year-old male, with no pre-existing diseases.
