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

Health insurance with OPD

A few years ago there used to be only a basic comprehensive health insurance plan. But in the current scenario many health insurance companies offering 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 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.

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 done without the hospitalization of the patient. There is no need to be hospitalized.

OPD Expenses May includes following expenses:

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

There are different kinds of OPD plans available. 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 cover 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 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.

OPD Benefits - OPD Cover
OPD Benefits

You can get following benefits if you have 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 plans available in India. ICICI Lombard, Max Bupa, Etc, are providing health insurance plan with OPD benefits.

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 the different expense limits. You can select the plan as per your convenience.

OPD Cover - How Much
OPD Cover – How Much

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.

OPD Claim Process

Normally, you can claim your outpatient treatment expenses through the reimbursement. However, some health insurance companies also have the facility of cashless claim.

In some companies, you can also submit your documents online to get the claim for the OPD expenses.


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

There are some health insurance plan with inclusive OPD benefit. Some insurance companies have the option of OPD as an add on cover also. You can also purchase it as an add on cover.

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