Health Insurance With and Without OPD Cover: 5 Key Observations

Health Insurance policy is a type of plan that provides financial protection against medical emergencies. Health Insurance mainly aims to cover hospitalisation expenditures. But, with growing healthcare requirements and rising healthcare costs, the notion of OPD cover Health Insurance has gained huge importance. So, in this guide, we will delve into the details of Health Insurance with OPD cover, along with five observations on why it is important.

In this fast-evolving world, it is crucial to make sure you have complete health coverage. As medical costs continue to increase, buying the best Health Insurance plan that provides coverage not only for hospitalisation but also for Outpatient Department (OPD) expenditures is essential. 

OPD or Outpatient Department is a healthcare unit where patients visit the doctor to consult their health issues without getting hospitalised. This can be a simple follow-up visit, performing tests for a diagnosis, buying medicines for treatment or check-ups for other chronic health issues that require regular doctor’s visits. And, you need to pay for these services, such as consultation fees, lab tests and medicines. This is where Health Insurance with OPD cover comes into the picture. It provides coverage for all OPD expenses. 

With the development in the Health Insurance sector, many insurers offer health plans with OPD coverage. This plan helps individuals from spending a large amount from their pocket when visiting doctors for consultations. 

So, now that you know about OPD coverage, let’s discuss the five observations why buying Health Insurance with OPD cover is important.

Health Insurance With and Without OPD Cover: 5 Observations

So, confused about Health Insurance with or without OPD cover? Check out the 5 observations below:

An OPD cover Health Insurance policy provides several services. Some of them are mentioned below:

While a normal Health Insurance plan without OPD cover provides expenses only if the insured person gets hospitalised for at least 24 hours. This policy extends to the day care procedures, in which less than 24 hours of hospitalisation will be required. 

Before buying any Health Insurance policy, you must know its benefits. So, here is a list of key benefits of buying an OPD cover Health Insurance policy.

  • You can avail the tax benefits for the premiums paid towards the OPD coverage.

  • This OPD policy extends its coverage to the costs of medicines and minor treatments that don’t need hospitalisation.

  • Generally, normal Health Insurance without OPD cover enables you to claim the coverage only after getting hospitalised. But, with OPD insurance, 24-hour hospitalisation is not required.

  • Having this cover gives you peace of mind for expenses incurred in a hospital OPD.

  • The waiting period for OPD cover can be lower than the normal Health Insurance policy.

  • Multiple claims are allowed under the OPD coverage.

Here are some exclusions that are not covered by the OPD cover Health Insurance plan:

  • OPD treatment outside India

  • Cosmetic dental treatment

  • No coverage for spectacles, hearing aids, etc.

  • Counselling sessions

  • Non-prescribed medicines

  • Weight loss treatment

Here are some key exclusions that are not covered by the normal Health Insurance without OPD:

Like a normal Health Insurance policy, the claim settlement process for an OPD cover Health Insurance policy generally has two methods:

  • Reimbursement Claims: In this process, the insured person needs to pay for the expenses incurred in an OPD and then gets the reimbursement by submitting the hospital bills, receipts and medical reports to the insurance provider. 

  • Cashless Claims: In this process, the insured person needs to avail medical services at network hospitals or clinics only and has to show the health insurance card at the hospital. Then, the insurance company directly settles the amount with the hospital.

5. Things to Consider:

When you purchase the Health Insurance with OPD cover, you must consider the following factors:

  • Coverage Limit: Before purchasing an OPD cover Health Insurance policy, one of the first things you should consider is the coverage limit it offers. You should ensure that the maximum sum insured covers your expected OPD expenses.

  • Network Facilities: Next, you should check the network facilities the health policy features. This is the most important point that will help you make an informed decision while choosing the right policy for you.

  • Deductibles and Premiums: When buying a Health Insurance policy with OPD cover, you must check the related deductibles and premiums. While the deductibles mean you need to pay from your pocket before making any insurance claim, the premiums indicate the Health Insurance cost you pay at regular intervals.

Difference Between Normal Health Insurance Without OPD Cover and Health Insurance With OPD Cover

The key difference between Normal Health Insurance and OPD cover Health Insurance is:

Normal Health Insurance Without OPD Cover

Health Insurance With OPD Cover

  • The expenses will be covered only if the insured person is hospitalised for at least 24 hours.  

  • But, for day care treatments, the insured person needs less than 24 hours of hospitalisation to cover the expenses under a regular health insurance policy.

Who Should Purchase an OPD Cover Health Insurance Policy?

Buying a Health Insurance policy with OPD cover is essential for getting financial help during a medical emergency. Generally, it is beneficial for anyone who wants complete Health Insurance coverage. So, let’s understand whom it is especially beneficial for:

  • Individuals with chronic medical conditions who require regular doctor consultations, diagnostic tests and medications.

  • Families with children or elderly members who may need routine check-ups, such as vaccinations and preventive health check-ups.

  • Individuals with diabetes, asthma or thyroid who need frequent medication and monitoring.

  • Individuals who want to avail benefits of preventive health check-ups and wellness services.

Final Words

As per the rising medical requirements and expenses, the Health Insurance sector has introduced OPD cover that provides coverage for the expenses incurred in an OPD. These expenses include doctor’s consultation fees, laboratory tests and pharmacy. Therefore, buying an OPD cover Health Insurance policy is one of the best options to manage your expenses easily during a medical emergency, where hospitalisation may not be needed but a complete medical check-up is required.

Furthermore, after knowing the benefits of OPD cover, if you want to change your existing Health Insurance plan with the OPD coverage, then you can opt for the Health Insurance portability option. This process allows you to transfer your existing plan from one insurer to another while keeping your existing benefits.

Ankit Singh



Nov 2023

351 posts

I’m Ankit Singh, a B Pharma graduate with over 5 years of experience as a medical content editor. I’ve completed internships and certified editing courses to hone my skills in simplifying complex medical information. My focus is on translating intricate medical content into clear, engaging material. Projects like revamping medical journals and creating educational materials have bolstered my confidence in this role. With certifications in hand, I’m committed to making medical knowledge accessible to all.View Profile

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