Why Health Insurance with OPD Cover Gaining Popularity?

Posted on: Jul 19, 2024 | 3 mins | Written by: HDFC ERGO Team

Why Health Insurance with OPD Cover Gaining Popularity?

A comprehensive health insurance policy offers a host of benefits to policyholders and eases worries during medical emergencies and planned procedures. In addition to some obvious inclusions, such as hospital bills, pre- and post-hospitalisation expenses, organ donor expenses and daycare procedures, some health plans also cover the OPD or outpatient department expenses of policyholders. In contrast, others offer it as a rider for an additional premium. Considering that health issues are increasing and OPD expenses can affect your monthly budget, taking health insurance with OPD cover can ease your financial burden. Let’s talk about this health insurance benefit in detail.

What is OPD in health insurance?

OPD cover, or outpatient department coverage, is an important inclusion in health insurance plans. It covers the medical expenses that policyholders incur without getting hospitalised. Some examples of OPD expenses are doctor’s consultation fees and the cost of diagnostic tests and pharmacy bills.

For example, suppose you are unwell and consult a doctor. The doctor prescribes some diagnostic tests, such as blood tests and an X-ray. If your health insurance policy covers OPD expenses, you can claim reimbursement for these medical bills.

While some insurance policies have OPD coverage as an in-built benefit, others offer it as an add-on with health insurance. If your health plan does not cover OPD bills, you can opt for this rider with your healthcare plan by paying an additional premium. Since OPD consultations and treatments are common, especially for minor illnesses and injuries, having health insurance with OPD coverage can help you save big.

Inclusions of an OPD cover

The following are the inclusions of health insurance with OPD coverage:

• Doctors’ consultation fees

• Diagnostic tests

• Investigative tests

• Pharmacy bills

Some insurance companies may also cover physiotherapy sessions and dental procedures under OPD coverage.

Benefits of OPD coverage in health insurance

Buying a health insurance plan with OPD coverage can ensure the following benefits to policyholders —

1. Better financial security:

Health issues are increasing by the day, and the OPD bills can add up to a substantial amount. Therefore, taking health insurance with OPD coverage can reduce your financial burden.

2. Timely healthcare:

With this health insurance cover handy, you can opt for timely consultation and healthcare without worrying about paying the bills from your pocket.

3. Reimbursement of pharmacy bills:

Thanks to medical inflation, the cost of medicines is skyrocketing. However, if you have health insurance with OPD coverage, the insurer will reimburse your hefty pharmacy bills.

4. Helps patients with pre-existing conditions:

Patients with pre-existing conditions often end up spending big on OPD expenses. They must consult doctors frequently, opt for prescribed tests and screenings multiple times a year, and take the prescribed medication for long periods. Therefore, OPD coverage can be highly beneficial for patients with pre-existing conditions.

Who should buy a health plan with this cover?

Taking health insurance with OPD benefit will extend the coverage of your health plan beyond hospitalisation. This add-on will cover your routine medical expenses and reduce your out-of-pocket expenses. While OPD coverage is recommended for everyone, it is strongly advised in the following cases —

• Chronic conditions:

If you are suffering from chronic conditions, you may have to avail yourself of frequent outpatient services for routine check-ups and medical emergencies. Therefore, a health plan with OPD coverage is highly recommended.

• Age-related health conditions:

Health issues and healthcare bills increase with age. Therefore, if you are nearing your 50s, having a health plan with OPD coverage can help reduce your financial liabilities. This add-on will cover your routine health check-ups, pharmacy bills, and other OPD expenses you incur in a policy term.

• Family history of health conditions:

If there is a family history of health conditions, such as high blood pressure, diabetes mellitus, heart disease, or cancer, you must opt for regular health check-ups to find underlying or inherited health issues early. Therefore, having health insurance with OPD coverage can save you from shelling out the bills from your pocket.

• Individuals with weakened immune systems:

If your immunity is weak, you are likely to suffer from infections and health conditions often. Since these issues can increase your OPD bills, a health plan with OPD benefits can help.

• Individuals prone to health issues and injuries:

If you are prone to health issues and injuries due to the nature of your job, or if you are a sportsperson or fitness enthusiast, taking health insurance with OPD coverage can ease your financial worries during routine check-ups and minor treatments.

Things to keep in mind when buying health insurance with OPD coverage

When buying health insurance with OPD coverage, make sure you consider the following —

1. Coverage:

Choose an amount that will easily cover your OPD expenses. While a high coverage will increase policy premiums, a low one can be inadequate.

2. Premium:

OPD coverage is available as an add-on with health insurance. Therefore, when buying health insurance with this benefit, it is wise to keep the premium within your budget. This will help you keep the policy active without burning a hole in your pocket.

3. Inclusions and exclusions:

The inclusions and exclusions of an OPD cover can vary from insurer to insurer. Therefore, instead of choosing a policy randomly, shortlist and compare a few and zero in on one that suits your requirements and pocket.

4. Network hospitals:

It is advisable to choose an insurance provider with reputed network hospitals in the city, with a few in the vicinity. You can reach the nearest network hospital and raise a cashless claim for your OPD expenses.

5. Claim Settlement Ratio:

The claim settlement ratio can tell you how reliable an insurance company is when it comes to settling claims. Therefore, do some research and choose a reputed insurer with a high claim settlement ratio.

Reasons to choose health insurance with OPD coverage

The following are some reasons to choose health insurance with OPD coverage:

1. OPD coverage makes your health insurance policy more comprehensive. While a health plan will cover your hospital bills and associated expenses, the OPD benefit will cover doctors’ consultation fees, the cost of diagnostic tests, pharmacy bills, and other OPD expenses.

2. OPD bills can take away a significant part of your savings every year. Therefore, taking this add-on for a nominal premium can reduce your financial liabilities.

3. With the OPD cover handy, you can opt for health check-ups and diagnostic tests as and when needed without paying the bills from your pocket.

Conclusion

Certain diagnostic tests and procedures are expensive and may take away a significant part of your savings. However, if you take health insurance with OPD cover, you can opt for the prescribed tests on time without the need to pay the bills yourself. Therefore, when buying health insurance, look for a plan with OPD benefits. If the same is not mentioned under policy inclusions, you can check with your insurance provider and take it as an add-on cover for better financial security.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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