What is an OPD cover health insurance?

Out Patient Department (OPD) cover Health Insurance

OPD Health cover 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 The policies planned and priced using then market’s situations are getting outdated as they cover hospitalization expenses of more than 24 hours.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.

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.