Know the essential features of health insurance with OPD cover and choose the right one
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Costs related to diagnostic tests, medicines and treatment of minor ailments can strain your income. OPD insurance can shield you from the rising costs of such medical bills. On Bajaj Markets, you can get health insurance with OPD cover starting at ₹160 per month.
Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.
The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
OPD (Outpatient Department) is the section in a hospital where your health issues are evaluated through diagnosis, treatment, and consultations without being admitted for an overnight stay.
OPD cover refers to coverage by insurers for the expenses incurred during OPD treatment, which includes consultations with doctors, health screenings and medicines. Certain insurance policies do not provide it as a full-fledged offering, but you can add it with an additional premium.
Outpatient treatments cost more than annual inpatient treatment, as per a study by Niti Aayog, Harvard University, and the Indian Institute of Population Sciences. A comprehensive insurance plan with an OPD cover can help identify potential ailments early when treatment is simpler and more affordable.
Here is an overview of the health insurance policies with OPD coverage you can get on the platform:
Policy Name |
Claim Settlement Ratio |
Premium Costs (per month) |
Aditya Birla Health Insurance |
99.41% |
Starting at ₹433 |
Care Family Health Insurance Plan |
87.10% |
Starting at ₹672 |
Disclaimer: The above-mentioned details are indicative and subject to change as per the insurance provider’s latest updates.
Health insurance plans with coverage for outpatient treatments provide financial relief against rising medical inflation. Here are a few other advantages:
Comprehensive Access to Healthcare: With cashless OPD coverage, you can get access to a broader range of medical care facilities
Timely Medical Attention: Many insurance plans with this add-on offer instant medical care for minor illnesses at reputed healthcare institutions
Preventive Care: OPD coverage encourages preventive care, which enables treatment before a disease worsens and requires critical care
Financial Ease: This coverage mitigates the need for out-of-pocket payments for regular OPD visits, which can be substantial in the long run
Tax Benefits: These plans also allow you to enjoy tax deductions towards the premium paid
Health insurance with OPD coverage offers a comprehensive range of benefits that can safeguard your health and finances. Here are the things to consider:
Scope of Coverage: Ensure that your plan covers expenses such as consultations with doctors, prescribed medicines, lab tests and more
Sum Insured: Choose the maximum amount you can claim against OPD expenses in a policy year carefully to prevent paying out-of-pocket
Cashless Claims: Consider an insurer that offers a simple and hassle-free process to file claims
Wider Network: Check if the plan has your preferred medical facilities in its network for convenience and trusted healthcare
Claim Settlement Ratio: Look for an insurer with a high CSR, which indicates higher chances of approval when you file claims with smooth settlement as well
Additional OPD Benefits: Some insurance plans may offer coverage for physiotherapy, vision, and dental care also
Here are some of the standard inclusions in an OPD cover:
Access to telephonic consultations with doctors
Costs of doctor consultations, including specialists
Diagnostic examinations and laboratory tests
Physiotherapy sessions and alternative therapies
Bills for prescription medicine
Routine health check-ups
Check the inclusions in your chosen plan to ensure it covers most of these expenses.
OPD insurance plans generally do not cover these medical expenses:
Treatment of injuries caused by participating in illegal activities
Medical expenses arising due to substance abuse
Costs related to cosmetic surgery and treatments
Medical treatment for self-inflicted injuries
Certain insurance plans also do not include coverage for pre-existing periods during the waiting period. Check this before you sign up for your policy.
You can easily assess, compare, and select a health insurance policy with an OPD coverage on Bajaj Markets. Follow these steps:
Go to the ‘Health Insurance Premium Calculator’ page
Fill in details like your age, address, and phone number
Click on ‘Get Quote’ and see the comprehensive plans with OPD cover available
Select one that best suits your requirements and add the required riders
Based on your choices, the premium amount you are required to pay will be displayed on the screen
Modify your choices to compare the premiums and select the right plan.
Frequently Asked Questions
What exactly is covered under OPD cover?
Under this cover, the insurer will pay for the expenses you incur during outpatient treatment. This includes diagnostic tests, physiotherapy, prescription medicines, and consultations.
How much does OPD cover cost?
The premium varies depending on your age, chosen plan, sum insured, and insurer. It typically increases your overall premium but can save you money in the long run if you use OPD services frequently.
How do I claim OPD expenses?
You can file a cashless or reimbursement claim by following the process outlined by your insurer.
What are the network limitations for OPD coverage?
You can now file cashless claims at network and non-network hospitals. However, some plans may restrict the number of times you consult a doctor or the type of treatment you get. They also even set a limit on the annual claim amount.
Are there any exclusions under OPD cover?
Yes, health insurance with OPD coverage does not include certain medical expenses. These include treatment for self-inflicted injuries, substance abuse and more.
What are the sub-limits in OPD cover?
Sub-limits are the maximum amounts that an insurer will reimburse for a specific expense. For example, there may be a sub-limit on consultations or specific tests.
Does an OPD cover offer tax benefits?
Yes, you can claim tax deductions on premiums paid for health insurance with OPD coverage under Section 80D.
Is OPD cover mandatory?
No, it is an add-on to your health insurance plan. You can opt for it based on your needs and budget.
Can I add an OPD cover later if I already have a health insurance plan?
If your insurance plan allows you to get an OPD add-on, you can do so. Insurers generally permit the addition of add-ons or riders only at the time of purchase or renewal.
How can I compare different OPD cover options?
To weigh different OPD coverage options, carefully assess the inclusions, exclusions, sub-limits, network hospitals, and claim settlement process. Consider factors like your age, health needs, budget, and preferred providers before making a decision.
