Health insurance is a type of plan that provides financial protection against medical emergencies. Health insurance is primarily intended to cover hospitalization expenses. However, with the increasing medical needs and rising medical costs, OPD covers health insurance It has become extremely important, so in this guide, we will delve into the details of health insurance with OPD cover and five observations on why it is important.
In this rapidly evolving world, it is important to have a complete health insurance policy. As the cost of healthcare continues to rise, it is essential to buy the best health insurance plan that covers not only hospitalization but also outpatient medical expenses.
An OPD or Outpatient Department is a medical unit where patients visit a doctor and discuss their health problems without being admitted to hospital. This could be a quick follow-up visit, tests for diagnosis, buying medicines for treatment or any other chronic health problem that requires regular doctor visits. And you have to pay a fee for these services, be it consultation fee, tests, medicines etc. This is where health insurance with OPD cover comes in handy. This insurance covers all your OPD expenses.
With the development in the health insurance sector, many insurance companies are offering health insurance plans with OPD coverage, which helps individuals avoid incurring huge out-of-pocket expenses while visiting a doctor for a medical consultation.
Now, now that you understand what OPD coverage is, let us discuss 5 points why it is important to buy health insurance with OPD coverage.
Health insurance with or without outpatient coverage: 5 considerations
So, are you confused about health insurance with or without OPD cover? Check out these 5 points below.
1. What’s included:
An OPD Coverage Health Insurance Policy offers several services, some of which are given below:
Regular health insurance plans that do not cover OPD only pay for expenses if the insured is admitted to hospital for at least 24 hours. The policy also applies to day treatments that require hospitalization for less than 24 hours.
2. Advantages:
Before subscribing to a health insurance policy, you should know about its benefits. So, listed below are the major benefits of subscribing to an OPD Cover Health Insurance Policy.
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You can get tax benefits on the premiums you pay for OPD coverage.
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This OPD policy also covers the cost of medicines and minor treatments that do not require hospitalization.
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Usually, in regular health insurance policies without OPD cover, you can claim compensation only after you are admitted to hospital, however, with OPD insurance, 24 hours of hospitalisation is not required.
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By taking out this insurance, you can have peace of mind regarding the costs incurred during outpatient hospital treatment.
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The waiting period for OPD coverage is likely to be shorter than regular health insurance.
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OPD coverage allows for multiple claims.
3. Exclusions:
The exclusions that are not covered under OPD Coverage Health Insurance Plans are as follows:
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Outpatient Treatment Outside India
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Cosmetic Dentistry
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Glasses, hearing aids, etc. are not covered.
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Counseling sessions
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Non-prescription medicines
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Weight loss treatment
The major exclusions that are not covered under regular health insurance without OPD are:
4. Billing Process:
Like regular health insurance, the claims settlement process for OPD cover health insurance usually has two options:
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Reimbursement Claim: In this process, the insured person has to pay the expenses incurred during outpatient treatment and then submits the hospital bills, receipts and medical reports to the insurance company for reimbursement.
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Cashless Billing: In this process, the insured person has to avail medical services only at the network hospitals or clinics and has to present his health insurance card at the hospital, after which the insurance company settles the amount directly with the hospital.
5. Things to consider:
While buying a health insurance policy with OPD coverage, you should consider the following factors:
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Coverage Limit: Before taking out a health insurance policy that covers OPD, one of the first things to consider is the coverage limit the policy offers. You need to ensure that the maximum insurance amount covers your anticipated OPD expenses.
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Network Facility: Next you need to check the network facility of your health insurance plan. This is the most important point that will help you make an informed decision while choosing the right insurance plan.
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Deductible and premium: If you are taking out a health insurance policy with OPD coverage, you need to check the relevant deductible and premium. While deductible means the amount you have to pay out of pocket before making a claim, premium indicates the health insurance cost you will pay on a regular basis.
What is the difference between regular health insurance without OPD cover and health insurance with OPD cover?
The main differences between regular health insurance and OPD cover health insurance are as follows:
Regular health insurance without OPD cover |
Health Insurance with OPD Coverage |
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Who should subscribe to OPD Coverage Health Insurance?
Having a health insurance plan with OPD coverage is essential to get financial assistance in case of medical emergencies. It is generally beneficial for those who want complete health insurance coverage. Now let us understand who it is beneficial for in particular.
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Individuals with chronic illnesses that require regular doctor visits, diagnostic tests, and medications.
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Families with children or elderly people who need regular health checks, including vaccinations and preventive health exams.
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People with diabetes, asthma, or thyroid conditions that require frequent medication and monitoring.
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Individuals who wish to benefit from preventive health screenings and health services.
The last word
With the increase in medical needs and medical expenses, the health insurance department has introduced outpatient coverage, which compensates for expenses incurred during outpatient care. These expenses include doctor’s consultation fees, laboratory tests, and pharmacy. Hence, during medical emergencies that do not require hospitalization but a complete medical check-up, taking out an outpatient health insurance plan is one of the best options to easily manage expenses.
Moreover, after understanding the benefits of OPD coverage, if you wish to change your existing health insurance plan to OPD coverage; Health Insurance Portability Optional. This process allows you to transfer your existing plan from one insurance company to another while keeping your existing benefits.