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What is an OPD health insurance?

Health Insurance Emergency Hospitalisation

Out Patient Department (OPD) cover Health Insurance

OPD Health insurance is a type of Health Insurance coverage where the insured patient is not required to be admitted in the hospital to get the insurance benefits.

Health insurance, by its very nature, aims to provide financial support during any health contingency incurred by the insured. The policies planned and priced using then market’s situations are getting outdated as they cover hospitalization expenses of more than 24 hours. Thus, Insurers realise the need to cover outdoor patient to provide a comprehensive health cover. One of the spokesperson of IRDA told that the price of outdoor treatment costs is twice the price of hospitalization expense a person face.
Until recently, insurers bar themselves from non-hospitalization expenses stating that the reliability of such checkups is hard to establish. But the growth in the number of chronic diseases, frequent treatments, expensive bills, lead to the popularity of Outpatient Department or Outdoor Patient department, hereby referred as OPD. These covers are introduced by the health insurers which cover the specific treatments which don’t require hospitalization of 24 hours.

Recommended Read : What is Day Care Hospitalisation?

Increase in number or patients for dialysis who do not require hospitalization for more than 24 hours, but incur huge medical expenses, this covers can benefit a lot. Women with complicated deliveries require a series of tests before delivery. This coverage will be beneficial to them too.

A typical OPD coverage includes many ‘day care’ covers, dental treatments and maternity expenses. The scope of coverage intuitively tells about the complexity in the process. Thus, before applying for such covers, the knowledge about the policy’s terms and conditions is very important.

À la carte

Health insurance policies enlist the OPD covers separately. Generally covers are enlisted as:

  • Doctor Consultation – A specified number of consultations according to the plan.
  • Pharmacy expenses – Pharmacy bills, sometimes up to an extent, are covered.
  • Diagnostics– Diagnostic test taken by the beneficiary.
  • Specialist Services – coverage for specific dental treatments, spectacles & contact lenses up to a certain extent.
  • Health check-up benefits – annual check-up is allowed for members above 18 years.

It should be noted that these covers are restricted up till a certain amount of sum assured. It may be like 25% of the sum assured or a cover of OPD transaction of Rs 5,000 for the sum assured of Rs. 1,00,000.

However, an OPD cover is considered as expensive because of high- volume transactions.

Although OPD covers are expensive but if a person knows how to get the best out of it, they can be considered as very beneficial. The success of Outpatient Department covers in countries having organised healthcare system is evident that this coverage are very useful if opted for with knowledge.

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  1. There are certain health insurance policies that cover both hospitalization and OPD treatment costs at panel hospitals and clinics on a cashless basis. The OPD cover is essential because normal health insurance policies do not cover the cost of dental treatment, preventive check-ups, periodic doctor consultation and so on. But OPD covers are an expensive option. It is more advisable to get a health card instead. Discount cards or health cards are not a substitute for hospitalization cover, but are special schemes that typically give you discounted rates on medical, health and drug expenses for a monthly or annual membership fee.

  2. What is the difference between OPD insurance policies and day hospitalisation policies? Is it the type of care that is covered?
    I know there are many types of care provided in hospitals where you can be admitted and released in one day, it seems like OPD is for recurring problems and needs, rather than emergency situations?

  3. This is a very informational article. I didn’t even know that such an insurance plan exists above the earth! When gone through the introduction just felt that the plan just serves for small disease but when read in detail, I was awesome stock! This is indeed a useful one. There will be many like me, who is unaware of these plans. I hope I should certainly share this to public. Huge thanks, Cheers!

  4. Necessity is the mother of invention. So the need and expense of OPD made the medical insurers initiate with this type of insurance too. No doubt the expenses are huge but if covered it provides great relief. What is the process for applying this cover? What is actually this OPD health insurance?

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