How OPD cover ensures enhanced protection in your health insurance cover

How OPD cover ensures enhanced protection in your health insurance cover

With the rise in health emergencies and increase in medical costs, an OPD cover that pays for non-hospitalisation-related medical expenses, can prove to be a valuable addition to your health insurance plan.Though health insurance has always been an indispensable purchase, it was only after the outbreak of the COVID-19 pandemic that awareness levels actually increased. In the past few years, health insurance has proved to be a strong shield against mounting hospital bills.
And while a regular policy worked adequately well until lately, the recent rise in newer viruses and infections has made a strong case for having 
OPD cover in one’s health policy.
The onset of 
COVID-19 caused a major panic wave and increase in hospitalisation. However, in recent times, medical experts have concluded that for a majority of people, these infections don’t require hospitalisation. This is where OPD or outpatient department cover comes into the picture.
The 
health insurance market has evolved to be more expansive; therefore, OPD cover as an in-built feature or an add-on is the recent positive development in this sector. Here is a detailed view of how OPD cover ensures enhanced protection in your health insurance plan.

OPD: A major component of healthcare expenses
Industry reports estimate OPD expenses to constitute 70 per cent of total healthcare expenses. It is regarded as the first step to any medical treatment. In case of pre-existing diseases (PEDs),these entail regular visits, and thus, higher medical bills, without even getting hospitalised.
Furthermore, the prevalence of an increasingly sedentary lifestyle doubles the risk of cardiovascular diseases, high blood pressure, obesity, and more. All this means a probable increase in doctor visits for routine check-ups in the backdrop of rising medical inflation.

Understanding OPD coverage

Industry reports estimate OPD expenses to constitute 70 per cent of total healthcare expenses. It is regarded as the first step to any medical treatment. In case of pre-existing diseases (PEDs), these entail regular visits, and thus, higher medical bills, without even getting hospitalised.

Furthermore, the prevalence of an increasingly sedentary lifestyle doubles the risk of cardiovascular diseases, high blood pressure, obesity, and more. All this means a probable increase in doctor visits for routine check-ups in the backdrop of rising medical inflation.

Understanding OPD coverage

OPD expenses are incurred during a visit to the clinic or hospital for consultation, check-up or tests. These expenses, which weigh heavily on a huge chunk of the population, are largely 

paid out of pocket by the patient/caregiver.


This is an expense which is common across all age groups, irrespective of the health condition. Whether it’s a PED requiring periodic consultation or contracting a viral infection, the addition of OPD cover makes sure you are financially prepared. The cover broadly includes:

Doctor consultation: It is helpful in family plans which also include cover for children or the elderly, where visits to the doctor are likely to be recurring. The plans now also offer cover for e-consultation with a doctor.

Diagnostic tests: Doctors mostly suggest diagnostic tests to accurately gauge a disease. Multiple rounds of tests can cost a fortune even before the actual treatment starts. Hence, by getting OPD cover, this added expense gets covered.

Pharmacy expenses: During the course of treatment, medicines prescribed can cost a lot. Even for regular treatments, getting the cost of medicine

What to consider before opting for the plan?

Since OPD has become an important part of health care expenses, it makes sense to carefully consider a few factors before opting for the plan. Apart from the costs mentioned above, the cover also guards against expenses like lab tests, X-rays, routine check-ups, vaccinations, dental, hearing and optical treatments.

However, the plan may not cover the cost of purchasing machines such as blood pressure monitors and thermometers, as well as expenses for vitamins, supplements, dietician fees, cosmetic treatments, and physiotherapy. The cover varies from plan to plan. So, remember to check the details before opting for the policy.

The range of the sum insured for OPD cover in some of the plans available today could be Rs 5,000-50,000. Some plans also give an option to upgrade the cover per policy as well as worldwide cover.

The plan may or may not have a waiting period. Some policies apply a 30 to 90-day waiting period before any kind of cover kicks in. As for PEDs, one should always bear in mind the waiting period and opt for cover well in advance.

Remember, cashless OPD cover would be available only in network hospitals. So the policyholder can only make a claim in these hospitals.

The last few years have witnessed a rise in health emergencies like never before. On top of that, the rise in medical inflation doesn’t make it any easier on your pocket.

Hence, OPD cover is a valuable addition to your health insurance for taking care of every kind of health issue. Whether it’s a basic fever or daycare treatment, having an OPD cover makes sure you are always covered, irrespective of the nature of your health condition.