OPD Insurance: Trim Your Medical Bills

With rising costs of healthcare, health insurance is mandatory for all. Astandard health insurance policy covers your medical expenses when you are hospitalised.

However, there are a plethora of medical expenses which does not require one to be hospitalised. These can be doctor consultations, clinic visits, diagnostic treatments and so on and these can burn a hole in your pocket as well. Outpatient department (OPD) health insurance covers these costs as well.

OPD cover in health insurance provides you coverage for outpatient treatment, meaning medical expenses incurred without hospitalisation as per your doctor's recommendations. “It covers expenses on doctor's consultations, visits to clinics, diagnostic tests, and medicines needed as an outpatient. The doctor consultations can be in a physical or an online format as per the convenience of the customer,” says Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com, an insurance portal.

According to data by Policybazaar.com, the demand for plans with OPD cover has quadrupled in the last three years. The primary driver behind selecting plans with OPD benefits is the accessibility to doctor consultations and diagnostic tests, cited by 80 per cent of customers.

Understand Coverage Limits
All outpatient visits are covered up to the limit of your OPD coverage (typically Rs 1 lakh). While OPD coverage offers financial support for outpatient care, it doesn't provide unlimited coverage. OPD plans typically come with sub-limits, not a single overall limit.

“These sub-limits can vary significantly, ranging from Rs 1,500 to Rs 50,000 per year depending on your chosen plan. This means your OPD coverage will reimburse you for expenses up to the sub-limit, not exceeding it,” says Syed Meraj Naqvi, CEO and Principal Officer, Riskbirbal Insurance Brokers.

So, while an OPD plan might offer a total coverage of Rs 1 lakh, it might have sub-limits for specific categories like consultations (Rs 5,000) or medicines (Rs 20,000). “It's crucial to understand these sub-limits when choosing a plan to ensure it aligns with your anticipated needs,” says Naqvi.

Cost Of OPD Cover
Some products offer OPD coverage as a part of their base in-built product offering. “Few products which do not offer OPD coverage as in built offering, offer the OPD coverage on optional/rider basis. However, in-built OPD cover is cost-effective and economical for the customer, as compared to an optional/ rider cover,” says Santosh Puri, Senior Vice President, Health Product and Process, Tata AIG General Insurance.

In the plans where the OPD feature is in-built, you need not pay any extra premium. “The additional premium for an OPD rider varies based on factors such as the insurance provider, the extent of coverage, policyholder's age etc. On average, it can range from 10 per cent to 20 per cent of the base health insurance premium (subjective to the plan features),” says Rakesh Goyal, Director, Probusinsurance.

Medical bills can add up quickly, even for minor illnesses and check-ups. OPD insurance helps you manage these outpatient costs by covering doctor consultations, tests, medications, and preventive care.

While coverage limits and sub-limits exist, understanding these details ensures you choose a plan that aligns with your needs. Consider built-in OPD options for cost-effectiveness and explore rider options if needed.