All about OPD cover in health insurance


08 Jun 2023

Unveiling the Benefits: OPD Cover in Health Insurance

A lot of medical insurance providers often include OPD (Outpatient Department) expenses in health insurance. Policyholders can submit claims for medical expenditures incurred without being hospitalized as part of the OPD coverage. Diagnostic and minor procedures, along with medications, are covered under a health insurance plan for outpatient treatment.

OPD cover in health insurance has the benefit of often covering costs that are not covered by conventional insurance plans. Health insurance with OPD coverage obviously offers additional financial security, and you should have it.

Features of OPD cover in health insurance plans

These are some of the features of OPD health insurance coverage:

  • First point of contact for medical care

  • Places a focus on illness prevention and health promotion

  • Accessibility to medical professionals

  • Makes screening and research for hospital admission easier

  • Ideal for general disease prevention or immunizations

What is included in OPD health insurance cover?

Under OPD, the following areas are covered:

  • Doctor's fees

  • Diagnosis tests

  • Routine check-ups, vaccination

  • Crutches or wheelchair

  • Minor surgeries, dressing

  • Dental treatment

  • Spectacles, contact lenses

What is excluded from OPD health insurance cover?

The OPD exclusions include the following:

  • Physiotherapy

  • Dietician fees, consultation

  • BP monitors, thermometers

  • Cosmetic treatment expenses

  • Vitamins and supplements

Why should someone purchase health insurance with OPD coverage?

  • Health insurance policies that include OPD coverage enable the insured to file claims for costs other than those spent during hospitalisation.

  • These plans provide higher tax advantages compared to standard health insurance policies. On the premium paid for certain health insurance policies, policyholders may claim a tax exemption.

  • This coverage also pays for pharmaceutical charges, helping customers who incur additional costs as a result.

  • OPD expenses may be claimed within 90 days after purchasing health insurance.

  • The insured may submit more than one claim for expenditure reimbursement during the term of the policy under the majority of health insurance plans with OPD coverage. There are a lot more services and transactions included in outpatient health care. This raises the financial worth of an OPD-covered health insurance policy over that of a standard health insurance policy.

  • Typical health insurance plans base claims and the amount assured on a 24-hour hospital stay. The sum promised under the OPD Cover is determined by the insured's age.

What are the requirements for buying OPD cover in health insurance?

When purchasing OPD cover in health insurance, there are no special requirements. A standard health insurance policy will often include an OPD cover. As a result, all of the policies' covers are covered by the qualifying requirements for the insurance. You won't need to fulfill any additional conditions as long as you complete the requirements for a particular health insurance plan that includes coverage for OPD procedures.

How do I submit a claim for health insurance OPD coverage?

By making a claim, you can use your health insurance policy's OPD cover advantages. This may be a reimbursement claim or a cashless transaction.

Cashless Claim - Inform your insurer within the timeframe specified in the policy and submit a cashless health insurance claim if you desire to obtain outpatient care at one of the network hospitals of your health insurance provider. If you use a cashless health insurance claim, you won't have to pay anything out of pocket for your treatment. The hospital and your health insurance company will deal with the bill directly.

Reimbursement Claim - You can submit a claim for reimbursement of the charges if you obtained OPD treatment at a hospital that is not in your network. Within two days after the treatment date, notify your medical insurance provider.

Treatments received outside of a hospital setting are regular and expensive. Getting OPD cover in health insurance is important if you want full health insurance coverage.

Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.