Should You Buy an OPD Cover in Your Health Insurance Policy?

The OPD marks the starting point for many of our healthcare journeys, serving as a place where a consultation with a trusted physician or specialist can make all the difference. It covers routine check-ups, essential diagnostics, and expert guidance for those minor health hiccups that don't necessarily need hospitalisation. Yet, the costs associated with these crucial OPD visits can accumulate rapidly. This is where the OPD cover in health insurance steps in, reassuring that your financial well-being is safeguarded, even for situations that do not necessarily need hospitalisation.

This article elucidates the importance of OPD cover in health insurance and the peace of mind it can bring to your healthcare experience. From doctor consultations for various health conditions to addressing those dental concerns your dentist has recommended, OPD cover extends to the spectrum of healthcare needs.

So, the question lingers: Does your current health insurance plan include OPD coverage, or is it time to explore this often-overlooked cover of healthcare protection? Read this article till the end to understand the intricacies of OPD cover and its potential impact on your health and financial well-being.

What Is OPD Cover?

Most individuals buy health insurance mainly to cover hospitalisation and related costs. Nonetheless, there are instances where you might need to seek medical care at a hospital or clinic for routine appointments or minor ailments like doctor consultations, undergoing diagnostic tests, or purchasing medications for treatments.

Such healthcare services are typically categorised under outpatient care, and a health insurance policy with an Out-Patient Department (OPD) cover provides financial protection for expenses related to doctor consultations, diagnostic tests, and treatments administered on an outpatient basis.

This provision effectively prevents you from having to dip into your personal finances to cover such OPD-related medical costs.

What Are the Types of OPD Covers?

1. Basic OPD Cover:

These policies typically cover basic outpatient expenditures, such as doctor consultations, diagnostic tests, and medication costs.

2. Comprehensive OPD Cover:

As implied by the name, these plans offer a more extensive array of protections, which may extend to dental treatments, eye care, and even certain alternative therapies, such as Ayurveda and Homoeopathy.

What Is the Procedure for Claiming OPD Cover Benefits?

Similar to regular health insurance plans, there are two options for requesting a claim for your OPD expenses:

1. Cashless Claim:

To file a cashless insurance claim for your outpatient treatment, you must choose a network hospital. It is essential to notify your insurer at least two days before your hospital visit. Upon arrival at the hospital, present your insurance card and complete the necessary paperwork.

2. Reimbursement Claim:

You can also opt for a reimbursement claim to cover your OPD costs. This claim request applies to outpatient treatment you receive at a hospital. You will need to fill out the claim form and provide the required documentation to your insurance provider. These documents typically include copies of bills, prescriptions, diagnostic reports, and any pertinent records.

After receiving your claim and associated documents, the insurance company will conduct a comprehensive assessment and process the claim accordingly.

What Are the Inclusions of the OPD Cover?

OPD coverage within a health insurance plan covers a range of services:

• Consultations with healthcare professionals, including physicians and specialists;

• Diagnostic tests, which may include blood tests, X-rays, and ultrasounds;

• Prescription medications prescribed by healthcare providers;

• Preventative health check-ups and screenings, such as annual health examinations;

• Minor outpatient procedures, such as the removal of foreign objects from the eye;

• Sessions for physiotherapy and alternative therapies, like acupuncture.

What Are the Exclusions of the OPD Coverage?

Here are some exclusions that apply to OPD coverage:

• Cosmetic and aesthetic procedures, including but not limited to plastic surgeries;

• Claims arising from engagement in illegal activities will not be covered;

• Claims resulting from substance abuse will not be eligible for reimbursement;

• Experimental or investigational treatments are not covered;

• Inpatient care, daycare procedures, and naturopathy treatments are excluded from the policy;

• Treatments pertaining to sterility, infertility, and associated medical conditions are not covered.

What Are the Benefits of Opting for an OPD Cover in Health Insurance?

1. Enhanced Coverage:

By opting for a health insurance plan that provides outpatient expense cover, you get an additional layer of protection that extends financial support for everyday medical costs.

2. Streamlined Online Processes:

The entire process, from acquiring health insurance inclusive of OPD coverage to initiating claims, is completely paperless, remarkably convenient, swift, and uncomplicated. Even claims do not necessitate physical paperwork.

3. Broad Spectrum of Covered Expenses:

Various expenses, including items like eyeglasses, contact lenses, hearing aids, and more, fall under the umbrella of this health insurance plan.

4. Convenient Cashless Claims:

Certain insurance providers offer a cashless claim system for covering OPD treatments. This simplifies the claims process and lowers any financial strains that may arise during medical treatments.

5. Multiple Claim Opportunities:

With this coverage, you have the flexibility to make multiple claims to cover your expenses.

6. Reimbursement for Pharmacy Expenses:

Your pharmacy bills are eligible for coverage under OPD cover, allowing you to receive reimbursement for the cost of medications.

7. Increased Tax Benefits:

Health insurance plans that provide OPD expenses offer greater tax deductions on the premium amount. Additionally, there will be no tax deducted at the source for claims.

Who Should Consider Buying Health Insurance with OPD Coverage?

1. Individuals with Weakened Immune Systems:

Buying health insurance that includes OPD coverage proves advantageous for those with compromised immune systems who frequently need OPD consultations. Moreover, it is beneficial for patients with pre-existing medical conditions such as thyroid disorders, hypertension, and diabetes, necessitating regular medical consultations.

2. Senior Citizens:

Senior citizens are more susceptible to health issues, often requiring OPD treatments such as dental procedures, cataract surgery, and other minor surgeries. Thus, it is crucial for them to consider senior citizen health insurance with OPD coverage, which not only covers routine health expenses but also OPD treatments, sparing them from significant out-of-pocket expenses during medical visits.

3. Working Professionals with Limited Group Medical Insurance:

Many companies provide group medical insurance to their employees, but these policies typically offer limited coverage. In such cases, individuals may opt for an additional health insurance policy with OPD coverage, as many group medical insurance plans do not include OPD benefits. This ensures better protection for working professionals who need comprehensive healthcare coverage.

To conclude:

Health insurance with outpatient department (OPD) coverage enhances the extent of protection within insurance policies. It enables policyholders to address their everyday medical costs, including consultation fees and diagnostic expenses. Given the increasing trend in routine medical expenditures like doctor's fees and diagnostic charges, this health insurance policy can be highly beneficial for any household.

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KETKI JADHAV is a Content Writer at PersonalFN since August 2021. She is an MBA (Finance) and has over seven years of experience in Retail Banking. Ketki specialises in covering articles around banking, insurance, personal finance, and mutual funds and has been doing it for over three years now.

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This article is for information purposes only and is not meant to influence your investment decisions. It should not be treated as a mutual fund recommendation or advice to make an investment decision in the above-mentioned schemes.