The coronavirus epidemic has raised everyone’s awareness regarding the importance of health insurance. It is no longer considered a choice, but rather a necessity for the safety of oneself and family. Considering the rising medical care expenses and the growth in lifestyle-related disorders caused by our sedentary lives, having health insurance coverage is vital.

Many people are unaware that health insurance coverage does not cover all of the expenses of curing an illness. Basic health insurance coverage, for example, only covers some in-patient or hospitalization expenses while excluding home treatment expenses such as diagnostic charges, doctor’s fees, and home care packages. Furthermore, most health insurance policies do not cover treatment expenses for medical care that does not require patient hospitalization.

According to various estimates, approximately 60% of medical care expenses for Indian patients are paid out of pocket. As a result, the exclusion of outpatient expenses has emerged as a major concern. Some of the biggest insurers have created (Outpatient Department) OPD solutions to cover outpatient charges such as diagnostic costs, doctor’s fees, pharmacy, and other items to bridge this gap.

Inclusions of an Outpatient Insurance Cover in Health Insurance:

Here are the details of OPD coverage in health insurance.

  • Doctor consultations
  • Diagnostic tests
  • Pharmacy expenses
  • OPD treatment
Exclusions of an Outpatient Insurance Cover in Health Insurance:

Here are the details of OPD coverage in health insurance.

  • Rejuvenation, pleasure, and other amenities or services.
  • Treatments for beauty, purification, detoxification, panchakarma, and so on.
  • The cost of spectacles, lenses, implants, hearing aids, prosthetic devices, braces, and other such items.
  • Treatment for OPD outside of India.
  • Routine checkups or preventative health check-ups.
  • Vaccination includes inoculation and immunizations except in case of post-bite therapy such as a dog bite.
  • Investigational experiments or treatments.
  • Infertility, sterility, and associated disorders.
  • Pregnancy complications, miscarriage, etc.
  • Dentures, dental treatment, and any type of surgery.
Benefits of OPD Expenses Coverage in Health Insurance

There are various benefits of having OPD coverage as part of your health insurance policy. Some of these are discussed further below:

  • Health insurance with OPD expense coverage, like basic health insurance, helps you save tax.
  • Without being hospitalized, OPD coverage allows you to claim for expenses incurred.
  • These policies also cover the costs of medications, diagnostic tests, and minor operations.
  • In contrast to plans that pay claims based on hospitalization, the sum insured under OPD cover is determined by the insured’s age.
  • You can claim OPD charges without having to wait a longer period.
  • Depending on the plan, you can make several claims during the same year until the maximum limit is reached.

Purchasing health insurance plans that provide extra coverage advantages not only allows you to save more money but also allows you to receive timely treatment without any financial concern. Even if your health insurance policy does not include OPD coverage, you can add it as an add-on benefit if it is available.