How Can OPD Coverage in My Health Policy Save Me Money?

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OPD or Outpatient Department coverage in health insurance helps you save money by covering your routine and non-hospitalisation expenses, such as doctor consultations, diagnostic tests, and dental treatments. This coverage is typically included in a health insurance policy as an add-on.


In fact, with medical inflation rising rapidly by 15% in India, as reported by the Economic Times, even these non-hospitalisation treatments can cost you a lot. This is why you must opt for this coverage even if it costs you some extra premium.


How Does OPD Coverage in Health Insurance Help to Save Money?



  1. Minimises Expenses on Doctor Visits


With the OPD cover, you can easily reduce your out-of-pocket expenses during a doctor's visit. Whether it’s a minor illness like a cold and a fever or preventive health check-ups, the cost of all of these expenses will be covered by your insurer.



  1. Covers Diagnostic Tests


Diagnostic tests, such as X-rays, CT scans, ultrasound, and blood tests, can be quite expensive if you require them frequently. This is when the OPD benefit comes into play to help manage these costs.



  1. Manges Pharmacy Bills


Apart from the doctor’s fee and diagnostic tests, through the OPD add-on, your health insurer will also cover the expenses of medicines prescribed by your doctor. This benefit will be highly beneficial for policyholders with medical conditions like hypertension or diabetes, which require regular medication.



  1. Reduces Financial Burden


OPD coverage automatically reduces the financial burden on policyholders by covering all outpatient services. In fact, with this benefit, policyholders can detect chronic conditions early, which often require expensive advanced treatments.


What Factors Should You Consider in Your OPD Coverage?



  • Coverage Amount: Before choosing the coverage amount in your health insurance plan, you must properly analyse the amount you generally spend on doctor visits or medical tests. This way, you can prevent your sum insured from being exhausted prematurely.



  • Sub-limit Clause: Many health insurance providers in India come with a sub-limit on the sum insured. Since this will determine the maximum amount you can spend on outpatient treatment, always choose the policy without any sub-limit.



  • Network Hospital List: Your insurer will only cover the costs of OPD treatment if it's taken at their listed network hospitals or clinics. This is why, before purchasing a policy, ensure your preferred hospitals are included in their list.



  • Waiting Period: To make a claim related to OPD treatment, you have to serve a waiting period. This period generally lasts 30 days for every policyholder and 12-36 months for policyholders with pre-existing conditions, such as asthma or diabetes.


Final Words


OPD coverage in health insurance is becoming an extremely popular add-on option among policyholders, as it offers protection beyond hospitalisation.


Especially the policyholders who require frequent medical attention must opt for this coverage. In fact, even if you do not fall under this category with this coverage, you can maintain a good lifestyle under the proper guidance of doctors.