Health Insurance with OPD Cover

OPD visits do not require a patient to get admitted to a hospital for more than 24 hours or as daycare treatment for minimum of 24 hours. OPD implies routine doctor visits, for which the insured can claim the expenses up to the limit specified in the policy documents. It covers the policyholder for medical consultations with general physicians, dentists, pediatricians, specialists, and orthopedics, etc. as per the need of the policyholder.

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      What is OPD Cover?

      The OPD cover refers to a health insurance cover that pays for the cost of outpatient treatment. It ensures that the health insurance provider covers the medical expenses of the insured incurred without hospitalization. Most health insurance plans do not offer an OPD cover and hence, it is usually available as an add-on cover.

      Some health insurance companies in India provide OPD insurance cover along with the basic plan. Check out the details of the OPD health insurance plans with their coverage benefits, and features. 

      Health Insurance Plans with OPD Cover in 2021 

      Check out the table below with different health insurance plans with OPD cover from different health insurers in India:

      OPD Health Insurance Plan

      Sum Insured (Rs.)

      Entry Age Criteria (yrs.)

      OPD Cover 

      Aditya Birla Activ Health Enhanced Platinum Plan

      Rs 2 lakh- Rs 2 Crores

       

      Min- 5 years in individual plan

      Min- 91 days in family floater

      OPD Limit- Rs 5000 to 

      Rs 20,000

      View Plan

      Bajaj Allianz Tax Gain

      N/A

      18-75 years

      OPD hospitalization expenses under a single 

      policy

      View Plan

      Bharti AXA Health AdvantEdge

      Rs 2 lakh- Rs 3 Crores

      N/A

      Optional OPD Cover

      View Plan

      Cholamandalam Family Healthline Plan

      Rs 2 lakh- Rs 15 lakh

      18-65 years

      N/A

      View Plan

      Care Family Health Insurance Plan

      Rs 3 lakh- Rs 6 lakh

      91 days & above

      Optional OPD Cover Rs 5,000 to Rs  50,000

      View Plan

      Digit Health Care Plus OPD Insurance Plan

      Rs 10,000- Rs 3 Crores

      18-65 years

      Wider Coverage

      View Plan

      Niva Bupa (Formerly known as Max Bupa) Go Activ Health Plan

      Rs 4 lakh- Rs 25 lakh

      N/A

      Up to 10 Cashless OPD Consultations

      View Plan

      SBI Arogya Plus Plan

      Rs 1 lakh- Rs 3 lakh

      18-65 years

      OPD Consultation/Treatment Cover

      View Plan

      Star Outpatient Care Health Insurance Plan

      Rs 25,000- Rs 1 Lakh

      18-50 years 

      OPD cover at all Network facilities

      View Plan

      See More Plans

      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      ₹1000 Cr worth of claims assisted in 2022-2023
      How we helped our customers

      Benefits of OPD Expenses Coverage in Health Insurance

      Health insurance plans with outpatient department cover prove to be beneficial for the policyholders in the following ways:

      • It is useful for patients who require frequent hospital visits for OPD consultations including something as basic as viral fever
      • The insured can get recompensed for hefty pharmacy bills
      • OPD cover is beneficial for patients with pre-existing medical conditions that often require frequent medical consultations
      • Those who are immunocompromised may also find OPD health cover beneficial
      • People suffering from chronic medical conditions such as asthma, diabetes, arthritis, thyroid, etc., who may require regular doctor consultations can benefit from OPD cover

      Note: OPD consultations are covered only in-network hospitals and clinics. 

      Which OPD Health Insurance Plan Should you Buy?

      Check out the health insurance plans with OPD cover in detail below:

      1. Aditya Birla Activ Health Enhanced Platinum Plan

      Aditya Birla Activ health enhanced platinum plan- cover for dental consultation and investigation the sum insured is Rs 2lakh to Rs 2 Crore. The policy is available on both individual and family floater basis.

      The policy covers General physician/ specialist visits for 10% of the OPD limit per visit, medicine and diagnostic cover 50% of the OPD limit.

      2. Bajaj Allianz Tax Gain Health Insurance Plan with OPD Cover

      Anyone between the age group of 18 years and 75 years can buy the Bajaj Allianz Tax Gain health insurance policy. It is a family floater health plan that covers out-patient expenses (OPD) and hospitalization expenses under a single policy.

      The policyholder can file a claim for dental procedures, spectacles, dentures, and crutches under the Tax Gain Plan. For cashless facility, it gives you access to more than 6500 hospitals across India. 

      3. Bharti AXA Health AdvantEdge Plan (Royal & Apex Variant)

      Bharti AXA Health AdvantEdge policy offers OPD cover for both dental and medical expenses. OPD cover is available in both the Royal and Apex variants of this plan. The OPD coverage provided is limited to 0.5% of the sum insured or a maximum up to Rs 1 lakh, whichever is less. 

      The out-patient expenses covered in this plan are in-network pharmacy, doctor consultations, diagnostic tests, and physiotherapy. The sum insured amount for Bharti AXA Health AdvantEdge Royal Plan ranges from Rs 5 lakh- Rs 50 lakh, and in the Apex variant it ranges from Rs 75 lakh to Rs 3 Crores.

      4. Cholamandalam Family Healthline Plan

      Chola Healthline is a comprehensive family insurance policy that provides health cover to families on both individual and floater basis. OPD cover can also be availed under this Family health plan as an add-on cover by paying an additional premium. It includes coverage for dental expenses, hearing aids, contact lenses, spectacles, etc.

      5. Care Family Health Insurance Plan

      Care Family health insurance plan offers comprehensive coverage benefits for a wider range of medical procedures and diseases. OPD insurance is provided as an optional cover, in which the insured can claim an amount equal to their medical bills at the time of reimbursement. 

      The OPD coverage amount ranges from Rs 5,000 to Rs 50,000 that you can opt for as per your requirements. There is no co-payment for members up to the age of 60 years.

      6. Digit Care plus OPD Insurance Plan

      Digit Care Plus is an OPD insurance plan that is specifically designed to cover Outpatient Department treatment expenses incurred by the insured during the policy term.  The expenses that can be claimed under this plan include medical consultations and examinations, diagnostic fees, medicine bills, surgical treatments, dental treatment, hearing aids, etc.  The policy also covers COVID-19 hospitalization expenses. 

      7. Niva Bupa (Formerly known as Max Bupa) Go Activ Health Plan  

      Niva Bupa (Formerly known as Max Bupa) GoActive medical insurance plan offers cashless OPD coverage benefits. It helps the policyholder save their hard-earned money that goes into regular hospital visits. The OPD coverage benefits are built into the base premium. 

      It provides up to 10 reimbursable/cashless OPD consultations with nearly 10,000 doctors through Practo. It includes consultations with a specialist, general physicians, pediatricians, dentists, and orthopedics, or with any other doctor as per the need of the policyholder.

      8. SBI Arogya Plus Health Insurance Plan

      SBI Arogya Plus policy covers hospitalization expense up to the sum insured i.e. Rs 1 lakh, 2 lakh, and 3 Lakh. The sum insured for OPD depends on the family type, age, and also premium. Maternity expenses are also covered up to the OPD limits. One unique benefit is HIV/AIDS cover up to Rs 50,000, mental illness cover, genetic disorders cover, and internal congenital diseases.

      9. Star Outpatient Care Health Insurance Plan

      This health insurance plan covers the Outpatient consultation expenses incurred at any Network Medical Facility in India. OPD claims under this health plan are permissible for diagnostics, dental treatment expenses, ophthalmic treatment expenses, and Non-allopathic treatment expenses, physiotherapy, and pharmacy expenses.

      Inclusions under OPD Health Insurance Plans

      The policyholder is entitled to avail of the following coverage benefits under health insurance plans with OPD cover:

      • Listed below are the inclusions of our OPD cover:
      • Diagnostic test
      • Doctor consultation
      • Investigative tests
      • Pharmacy expenses 

      It works as a cushion for your savings and helps you start your treatment right on time without worrying about these small expenses.

      How to Buy Health Insurance with OPD Coverage?

      Buying a health insurance policy with OPD cover online is simple and quick. Check out the steps below to get a suitable policy for yourself:

      • Visit Policybazaar.com and select a health insurance plan with OPD cover
      • Provide your contact details like your name, email id,  mobile number, contact details, pin code, age, gender, and click on ‘Get Quote’
      • Confirm any pre-existing diseases or medications
      • Now select the policy sum insured, duration, and other add-ons as per your requirement 
      • Compare the premiums and click on the Buy Now options
      • Once you pay the premium online, the policy will be issued and emailed to you on your registered email-id.

      For more details, you can write to us at care@policybazaar.com

      FAQs

      • Q1. What is OPD cover in health insurance?

        Outpatient Department treatment or OPD refers to doctor visits required for medical treatments and diagnosis as per the prescription. OPD visits can be to a clinic or a hospital. The only difference is that OPD treatments do not require hospitalization.

      • Q2. What is cashless OPD?

        Cashless OPD refers to the coverage for doctor’s consultation fees, dental treatment, diagnostic tests, eye treatment, medicines, etc. All these expenses are skyrocketing with medical inflation, and therefore a health insurance plan with outpatient consultation cover is highly beneficial, especially during the ongoing COVID-19 pandemic. 

      • Q3. Does Star health insurance cover my OPD expenses?

        Star Outpatient Care health insurance policy covers most of the outpatient consultation expenses. You can file a health insurance claim for your doctor fees, pharmacy bills, Diagnostic tests, dental treatments, non-allopathic treatments, and other therapeutic procedures.

      • Q4. What is the limit for OPD expenses under health insurance?

        The OPD limit is generally defined in the policy wordings and is usually a part of the sum insured. Any claims or reimbursements filed under OPD are deducted from the overall sum insured.

      • Q5. Can I buy OPD health insurance online?

        Yes, you can buy OPD health insurance online from Policybazaar. There are different health insurance companies in India providing OPD cover in their basic health plan or as an add-on. You can call us at 1800-807-8787 or write to us at care@policybazaar.com

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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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      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

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