What Is An OPD Insurance?

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What Is An OPD Insurance?
What Is An OPD Insurance?
Meghna Maiti - 06 February 2024

Traditional health insurance covers hospitalisation, surgery, and medical procedures but often excludes certain expenses, which the policyholder needs to bear. That’s why including an outpatient department (OPD) rider in your regular health insurance is vital, particularly for those who need frequent medical care but may not require hospitalisation. There are also standalone OPD insurance policies available in the market that provide access to doctors, clinics, and diagnostic centers all across India. Here are the details about what it covers and why you should opt for OPD insurance cover.

What Does It Cover?

  • It offers a spectrum of coverage, from routine doctor visits to specialised consultations, which extends to medication, routine screenings, and other outpatient services.
  • It also offers features such as teleconsultation, unlimited online consultations, and in-clinic consultation cover.
  • Some policies extend OPD benefits to holistic wellness services, including diet and nutrition, and consultations for mental health needs.
  • These incorporate physical fitness coverage too, giving policyholders access to network gymnasiums at discount.

What Does It not Cover?

  • Expenses related to spectacles, lenses, implants, hearing aids, prosthetic devices, braces, and similar items.
  • Rejuvenation facilities and activities, routine and preventive health check-ups.
  • OPD treatments conducted outside India.
  •  Pregnancy complications, miscarriages, and similar issues.
  • Vaccination, inoculation and immunisation, except in the case of post-bite therapy, such as for a dog bite, and infertility, sterility, and related conditions.
  • Dental treatment or dental surgery.

Should You Go For It?

  • Adding an OPD rider to your standard health insurance policy may increase the premium amount by a few thousand to several thousand rupees per year, depending on the coverage offered to the policyholder.
  • This cover can fill the gaps in your health insurance plan and minimise out-of-pocket cost.
  • It can act as a financial buffer and provide a layer of security to tide you through difficult times.
  • It can be beneficial for those needing frequent medical attention. For individuals without significant health concerns, an OPD cover may be unnecessary.
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