OPD Cover: Should You Buy Health Insurance With OPD Benefits?

OPD cover insurance
OPD cover

A few years ago there used to be only a basic comprehensive health insurance plan. But in the current scenario, many health insurance companies offer OPD cover. But the question is why it is required.

What is the difference between basic comprehensive health insurance and OPD plans? is it really beneficial for you? Suppose, someone is suffering from an illness/disease and he visits the hospital. Now there may be the following situations:

1- Day Care Treatment (Hospitalization required for a few hours and less than 24 hours)

2- Inpatient Hospitalization( Hospitalization of more than 24 hours)

3- Treatment in Outpatient Department (OPD)

Normally your basic comprehensive health insurance policy covers 1st and 2nd options. However, if you have OPD cover in your health insurance policy then All three options will be covered.

It is not necessary that every time you need to get hospitalized. In some cases, you just only need some specific treatment in the Outpatient Department of the hospital or in any clinic, etc. There may be any seasonal disease/illness or minor injury where you don’t need to go for hospitalization.

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What is OPD Treatment?

Basically, OPD means Outpatient Department. In this case a patient visit to the Hospital/Clinic, etc for any illness/injury/Disease. Treatment and consultation did without the hospitalization of the patient. There is no need to be hospitalized.

OPD Expenses May include the following expenses:

  • Doctor Consultation Charges
  • Medicine Bill
  • Diagnostic Test Bill
  • Dental Treatment Expenses
  • Health Checkup

There are different kinds of OPD health insurance plans available in the market. You should always read the coverage (OPD amount, Terms and conditions, etc) details in your health insurance policy.

Benefits of OPD Cover in Health Insurance?

If you have OPD coverage in your health insurance policy then you can claim expenses related to outpatient treatment. Let’s understand it with an example:

Suppose Mr. Srivastava is not feeling well. He visited a clinic near his residence. The doctor advises him to go for a blood test and take a particular medicine for 5 days. After five days, Mr. Srivastava visited the clinic again.

As per the report, the doctor advised him to take medicine for another 5 days. He will be fine after that. He did the same and he is fine after taking the medicine. In this case, Mr. Srivastava paid the following bills:

  • Doctor Consultation Charges.
  • Medicine Bill.
  • Diagnostic Test Bill.

Mr. Srivastava is having a health Insurance policy also. So, he contacted his insurance company. But his insurer said that he can’t file the claim for these expenses because there is no OPD cover in his plan. You can get the following benefits if you have a health insurance policy with OPD benefits:

  • Medicine and Pharmacy Bill
  • Diagnostic Test Cost, Dental treatment cost, Health Checkup, etc
  • Tax Benefit under section 80D.

You may claim the above benefits under the OPD plan. But you should also check that which expense is covered in your plan and which is not. There are multiple OPD plans available in India and you have multiple options. ICICI Lombard, Max Bupa, Etc, are providing health insurance plan with OPD benefits. You can explore some companies before finalizing the policy and get a better deal.

How Much OPD Cover Should You Select?

Normally, insurance companies do not offer you OPD benefits for an unlimited amount. There are many plans available with the benefits of different expense limits. You can select the plan at your convenience.

In my personal opinion, you should choose a higher amount of OPD Limit. But simultaneously you should also analyze the price factor. You should also consider family size, Age of members for the selection of OPD coverage.

You should choose your insurance policy and OPD coverage very carefully. If you don’t have any idea about health insurance, you can take the guidance of a good health insurance advisor. If an insurance agent is knowledgeable, then he or she may guide you a better policy.

However, you should not be fully dependent on your insurance agent. You should do some research and product by yourself also. So that you be aware that you are buying the right health insurance policy with sufficient OPD cover.

OPD Claim Process

Normally, you can claim your outpatient treatment expenses through reimbursement. However, some health insurance companies also have the facility of cashless claims. In some companies, you can also submit your documents online to get the claim for the OPD expenses.

Process to claim OPD benefits of most companies is more or less the same. However, there may be differences also, so you should read your terms and conditions. And you should know what is the quick process to get your claim smoothly and on time.

If you have taken your policy through an insurance agent then you can also take help from your agent. So that you can complete your documents in one shot to get the benefit of OPD cover. However, if you purchase your policy directly online, then also you can contact your customer care and know the complete claim process of OPD cover.


Every medical treatment doesn’t require hospitalization and spend many days in a hospital. In some cases, you may only visit the doctor/hospital or nursing home, etc, and take the required treatment in the outpatient Department (OPD).

There are some health insurance plans with inclusive OPD benefits. Some insurance companies have the option of OPD cover as an add-on cover also. You can also purchase it as an add-on cover also. While choosing health insurance policies with OPD coverage, you should compare policies in multiple companies.

You should compare its prices, features, OPD coverage, claim settlement ratio, etc. I hope this article was good enough to explain all the required things and was helpful for you.

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