Health insurance coverage for outpatient department (OPD) treatments typically covers medical costs for patients who do not require hospitalisation, such as expenses on consultations, diagnostic tests, and prescription drugs.
Most health insurance plans do not offer an OPD cover, and it is usually provided as an add-on. However, some health insurance companies in India provide OPD insurance coverage along with the basic plan.
“OPD health insurance, as the name suggests, covers outpatient treatment expenses without the need for hospitalisation. It is not entirely new, and insurers are experimenting with the model,” says Ravichandran N, chief technical officer at Kotak Mahindra General Insurance.
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Advantages of OPD cover
Less Out-Of-Pocket Expenses: An OPD cover can reduce the financial burden of unexpected medical costs, such as consultation fees, diagnostic tests, and prescribed medications that may arise during a regular check-up.
More Convenient: An OPD cover eliminates patients’ cost concerns associated with routine check-ups or minor illnesses, encouraging them to seek prompt medical attention, which can result in better health outcomes.
Comprehensive Coverage: An OPD cover can offer inclusive coverage for different medical expenditures, such as dental and eye care, which are frequently excluded from conventional health insurance policies.
Tax Benefits: The premiums for OPD cover qualify for tax deductions under Section 80D of the Income Tax Act, 1961.
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Disadvantages Of OPD cover
Higher Premiums: OPD cover may come at a higher cost than standard health insurance policies due to its extensive coverage of medical expenses typically excluded in other insurance plans.
Limited Coverage: OPD cover can have exclusions. It may not include cosmetic treatments and alternative therapies.
Exclusions: OPD cover can have exclusions. Cosmetic treatments and alternative therapies may not be covered.
Limited Availability: Not all Indian insurance companies offer OPD cover, and it may not be readily accessible in specific areas or for individuals with pre-existing medical conditions.
“One of the biggest challenges in this model has been setting up a network of trusted healthcare providers to offer seamless benefits. In our ecosystem, we prefer to visit our neighbourhood family general practitioner for general ailments, and insurers have to work towards making customers visit the insurer’s medical network. From the insurer’s perspective, the claims have to be seamlessly managed with adequate control,” adds Ravichandran.
An OPD cover is a valuable supplement to a health insurance policy, particularly for those who need regular medical care. Nevertheless, assessing the policy’s terms and conditions, including its coverage and exclusions, is crucial before deciding. Furthermore, people should compare the cost of an OPD cover with the potential savings in out-of-pocket expenses to determine if it is a wise investment.
