OPD Cover: Is it an In-built or Add-on Cover?

Rahul-a Delhi-based banker was out for a week vacation with his family. Everything went well until his father met with an accident and broke his leg. This made Rahul to put a halt on his vacation to return to Delhi. It goes without saying that the treatment his father had to gone through did cost Rahul an arm and a leg during hospitalisation. Even after getting his father discharged, he ended up paying a huge amount for every OPD visit.

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    This could be you as well if you don’t plan your finances well. And when it comes to planning your financial portfolio, health insurance becomes an imperative choice to be added. Health insurance is not a new term. With medical expenses soaring at a rapid pace, people have started opting for health insurance plans in India to get financial assistance. But very less people are aware of its advanced features. One such feature is health insurance with OPD cover!

    What’s OPD Cover?

    OPD or the Out-patient Department is an essential unit of a healthcare centre, where people can be treated without getting hospitalised. This can be a follow-up visit, a visit for showing test reports or check-ups for other chronic health conditions that require frequent doctor’s visit. And a health insurance policy covering those expenses is called OPD Cover.

    With the evolution in the health insurance sector, many health insurance providers have come up with plans that cover OPD benefits. That restrains the insured from paying a huge amount from his/her pocket in medical visits. So, one needs to know the in-and-out of this cover. Let’s brush up your knowledge here!

    Is it an In-built Cover or a Rider?

    First of all, it entirely depends on the insurer how they offer this cover. While some offer this OPD cover as an in-built benefit, some others may offer this as a rider with an additional premium. So, it is always recommended the check for the plans, compare them as per your insurance requirement and buy.

    As we mentioned above, OPD cover can be opted either as a part of your health plan or as a separate rider, the scope of coverage will be extensive no doubt, however, it might cost an additional premium or the plan may come with a higher premium.

    Tips for Buying Health Insurance with OPD Cover

    Ensuring sufficient health coverage is essential to remain on the safer side in times of need. There is no point of buying a policy that can’t suffice your requirements. Same goes for choosing an OPD cover. If your coverage is not sufficient, that can adversely affect your pocket. So, here are some pointers to consider while selecting a health insurance policy with an OPD cover in India.

    • Check for the Credibility of the Insurer: It is always recommended to buy a policy from a renowned insurance provider in India. This will help you in two ways- you will not end up compromising on whatever is promised at the time of buying the policy. Secondly, an insurer with a decent claim settlement ratio and a good market reputation will always be upfront for settling a claim on time. This mitigates the chances of your claim getting rejected.
    • Choose the Coverage Amount Smartly: It is important to select the coverage amount mindfully. Sufficient sum insured means you’re extensively covered under a health insurance plan. Moreover, in case of choosing the OPD cover, always look for the procedures that are included in the plan.
    • Check for the Waiting Period: Another important factor to consider is waiting period clause. Mostly health insurance policies come with a waiting period clause for covering pre-existing illness. That might be applicable in case of OPD coverage as well. Diseases like diabetes wouldn’t be covered right after the policy is bought. A pre-decided waiting period will be applicable. A policy with the minimum waiting period is always a good pick.
    • Co-payment Clause: Usually there are insurers who offer this cover along with the health insurance with no age-based co-payment. It is recommended to go with them when it comes to choosing a plan with OPD cover.

    Key Benefits of Having Health Insurance with OPD Cover

    OPD insurance enables the policyholder to enjoy the following benefits:

    • The insured can enjoy tax benefits for the premiums paid towards the health insurance policy with an OPD cover.
    • With this cover, the insured will be rest-assured for the OPD expenses incurred.
    • The policy coverage extends to the expenses of medicines and minor procedures that don’t require hospitalisation.
    • Usually, normal health insurance without OPD cover will allow the insured to claim the policy only after getting hospitalised. It is not the case with OPD insurance; there is no need of 24 hours hospitalisation.
    • The waiting period clause can be lower as compared to the regular health insurance.
    • The insured is liable to claim for the multiple times under a health insurance policy.

    To Conclude!

    Thankfully, the health insurance sector has been revamped to introduce OPD cover that includes the expenses incurred in an OPD. Many recent plans are designed in a manner to offer coverage for multiple expenses such as doctor’s consultation, cashless claims under OPD cover, dental treatment expenses, laboratory test etc. No doubt, availing treatment from a reputed private hospitalisation means your savings are at stake, be it for a hospitalisation or an OPD visit. Hence, having a health insurance policy with OPD benefit can help you plan your expenses smoothly in the time of a medical emergency, which may not require being hospitalised but thorough medical supervision of a physician.

    Written By: PolicyBazaar - Updated: 30 July 2021
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    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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