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Visit A Doc Frequently? Opt For OPD Cover

By Sarbajeet K Sen
April 19, 2022 08:54 IST
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Most traditional health insurance plans didn't cover the cost of such treatments earlier, but several recently launched policies do offer such coverage -- some as a rider, and a few as standalone covers, points out Sarbajeet K Sen.

Illustration: Uttam Ghosh/

A large portion of healthcare expenses are incurred on out-patient department (OPD) treatments, a fact that was highlighted especially during the three waves of COVID-19.

Most traditional health insurance plans didn't cover the cost of such treatments earlier, but several recently launched policies do offer such coverage -- some as a rider, and a few as standalone covers.

"The demand for OPD covers has risen significantly, especially after the third wave, as the pandemic had after-effects on people's health. Such people want to consult their doctors regularly. Since such check-ups don't require hospitalisation, an OPD cover becomes vital for them," says Naval Goel, founder and CEO,

The growing preference for telemedicine has also boosted demand.

"Post Covid, more customers prefer products that cover online OPD and e-consultations," says Amit Chhabra, head-health and travel insurance,

Ambit of coverage

This cover reimburses OPD expenses such as doctor's fee, cost of medicines, costs of diagnostic tests, and other treatments that don't require hospitalisation.

For example, if the insured meets with an accident and suffers a fracture, this policy will pay the doctor's consultation fee, the costs of plastering the limb and medicines.

A standard health insurance policy won't cover a fracture caused by an accident if the patient does not get hospitalised.

These policies also come in handy when the insured undergoes dental treatment.

"Health insurance policies usually don't cover medical costs incurred on dental treatments like fillings, root canal, tooth extraction. In fact, even those policies that cover a few listed day-care treatments, don't cover dental treatments. However, many of the recently launched health insurance plans that come with OPD covers provide protection against dental issues as well, including the cost of dentures up to a certain limit," says Chhabra.

Key exclusions

OPD policies don't cover the cost of cosmetic procedures, vitamins and supplements, and physiotherapy sessions.

"The exclusions for OPD covers are similar to those for health insurance plans where the facilities, services or treatments availed for rejuvenation, pleasure, beauty, spectacles, lenses, implants, hearing aids, prosthetic devices and braces are not covered," says Goel.

Read the policy wordings carefully to understand the exclusions.

OPD covers also have a waiting period.

"Some of the standalone OPD plans that have been launched recently come with merely 90 days or lower waiting period," says Goel.

Many of these policies also don't have any sub-limits.

Impact on premium

No standard OPD product is available, so buyers should take into account both the benefits offered and the sum insured while comparing premiums, which are on the higher side for these policies.

"Since OPD charges are high and are incurred frequently, health insurance plans that include OPD coverage are relatively expensive," says Goel.

Run these checks

Check if the policy comes with restrictions.

"Is there a limit on the number of chemists from whom you can buy medicines?

Is the claim process cashless or reimbursement? Cashless is preferable.

In the reimbursement option, check if you can file whenever you want, or only once a year," says Kapil Mehta, co-founder and managing director, Secure Now Insurance Broker.

Another major point you should check at the time of purchase, according to Mehta, is if you make an OPD claim that should not cause the no claim bonus (NCB) you have accumulated in the main policy to get affected.

Who should buy it?

OPD covers are beneficial for those who have to pay frequent visits to a doctor.

"It is not always advisable to include an OPD cover in your health policy as it generally comes with limits which a policyholder can pay out of his own pocket. However, in case a person has a pre-existing or chronic disease, low immunity, or is highly prone to vector-borne diseases, such a person should opt for an OPD cover," says Goel.

Feature Presentation: Aslam Hunani/

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Sarbajeet K Sen
Source: source