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Health Insurance with OPD Cover: Check Coverage & Benefits

OPD in health insurance is a term used to describe outpatient services that are not covered under regular health insurance plans.

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Home / Health Insurance / Health Insurance with OPD Cover

Even though in-patient medical expenses tend to be significantly higher, outpatient costs can accumulate over the year and can burn a hole in your pocket. A recent survey by ET Prime revealed that nearly 62% of healthcare costs in India are towards Out-patient Department (OPD) expenses. With rising healthcare costs, it is wise to choose a medical insurance plan with OPD cover. This article helps you understand the benefits of Health Insurance with OPD Cover Online

What is OPD Cover in Health Insurance?
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OPD in health insurance is a term used to describe outpatient services that are not covered under regular health insurance plans.

Not all medical issues require hospitalisation. For example, you may need to visit the OPD to treat a minor illness or injury. During such instances, you may visit the clinic or the OPD of the hospital, get the doctor to assess the medical issue, may require a diagnosis through a lab test, and buy medicines at the pharmacy to treat the medical problem. For these services, you pay for doctor consultation fees, lab tests, and medicines.

Benefits of OPD Cover in Health Insurance Policy
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Here are the advantages of OPD cover in Health Insurance Policy.

Inclusions of an Outpatient Insurance Cover in Health Insurance
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Here are the coverage details of OPD cover in medical insurance.

Exclusions of an Outpatient Insurance Cover in Health Insurance
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Here are the exclusions of OPD cover in medical insurance.

Claim Settlement Process
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Here are two types of processes to raise a claim for OPD expenses.

Reimbursement Claims
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Upon completing the OPD treatment, you need to upload the bills and all relevant documents by logging in to your account via ACKO’s website or mobile app to process the reimbursement.

Cashless Claims
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You can avail of OPD treatment at any of the ACKO’s network hospitals or Day Care centers by submitting your e-health card and requesting to initiate the cashless claim.

Difference Between Day Care Treatment and OPD Treatment
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Day Care treatment and OPD treatment are similar. However, there is a slight difference between the two as they differ in the technical aspects. Here are the differences between the two types of treatments.

Day Care Treatment

OPD Treatment

It requires hospitalisation not more than 24 hours.

It does not require hospitalisation.

Settlement of claims will not be honoured if hospitalisation is not more than 24 hours.

Settlement of claims will be honoured only for non-hospitalisation.

Example: A root canal treatment that does not require hospitalisation is categorised as OPD treatment. In contrast, a dental surgery needed due to an accident and required hospitalisation of fewer than 24 hours can be classified as Day Care treatment.

Difference Between Out-patient Department (OPD) Treatment and In-patient Department (IPD) Treatment
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There is a clear difference between the two types of treatment. Here are the differences between OPD and IPD.

OPD

IPD

A visit to a doctor or a clinic.

Admitted for appropriate care and attention.

It does not require hospitalisation.

It requires hospitalisation for more than 24 hours.

Example: A root canal treatment is considered OPD treatment, while a heart surgery requiring hospitalisation for more than 24 hours is regarded as an IPD treatment.

Why Should You Get a Health Insurance with an OPD Cover?
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Here are the reasons why you should consider buying medical insurance with an OPD cover.

Who Should Buy OPD Cover Health Insurance?
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Health insurance plans that provide OPD coverage are helpful for those who are looking to extend the primary plan’s coverage apart from coverage for hospitalisation. If you fall into any of the three categories, you should consider Health Insurance Plan with OPD Cover.

Frequently Asked Questions about Health Insurance with OPD Cover
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Here are some of the most commonly asked questions about health insurance plans with OPD cover.

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Can I avail of tax deductions on health insurance plans with OPD cover?

Yes, you can claim tax benefits on health plans with OPD cover under Section 80D deductions of the Income Tax Act.

When are the instances when I can utilise my OPD cover?

You can use the OPD cover in the health insurance plan for minor surgeries or treatments that do not require hospitalisation.

Can I buy an insurance plan that covers only OPD treatment?

It depends on the insurance company and the plans they offer. You need to review the plans before you buy the plan that provides coverage only for OPD treatment.

How do I buy health insurance with OPD cover?

OPD cover in health insurance is offered as an add-on cover at an additional premium. However, it may differ between insurance companies. For example, some plans are bundled with OPD cover, while other plans offer OPD cover as an add-on. Therefore, it is prudent to check the coverage details so that you can make an informed decision.