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Why It Is Important To Buy An OPD Cover With Health Insurance

With medical inflation and the charges levied for simple tests, increasing health insurance with OPD cover makes perfect sense.

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There is an increased awareness of the importance of insuring health amidst the pandemic. Many young people especially still go for a low sum insured as they do not worry about hospitalisations. They however do not take into account the consultation fees and expenses attached to tests, X-ray, etc.  Hence they do not see the importance of an OPD cover. Out-Patient Department(OPD) is where the treatment and diagnoses are done during the visit to a clinic or a consultation room at a multispecialty hospital. OPD treatment does not require hospitalisation.

With medical inflation and the charges levied for simple tests, increasing health insurance with OPD cover makes perfect sense. Common workout and gym injuries like sprained ankles, shoulder and knee injuries, dislocation, etc. do not require hospitalisation, but they do require a prescribed treatment. If you opt for OPD benefit in your health insurance, it will cover the consultation fee and any other charges like X-rays, bandages, etc.

What is covered under OPD health Insurance?

  • Doctor consultation fee: Fee for medical consultation and examination by any medical practitioner to assess one’s health in case of any illness falls under OPD cover. Doctor consultations are quite common, and the current situation has increased this even more with people going for medical consultation even in the case of cold and fever. 

  • Diagnostic charges and medication: It covers medical procedures like X-rays, scans, blood tests, etc. done by diagnostic centres that are used to diagnose and confirm the illness for treatment. Tests and scans are particularly important for treatments and can cost you depending on the type of procedure. Expenses like drugs and medicines prescribed by the doctor also fall under OPD cover.

  • Minor surgical procedures: Minor surgeries like POP, suturing, dressing for accidents and animal bites do not require hospitalisation however is covered under this.

  • Fractures: Fractures do not require hospitalisation in most of the cases; however, they need expert medical assistance. For example, a leg fracture can cost one anywhere from INR 5,000 to INR 50,000 depending on the severity of the condition.

Why you should take an OPD cover with your health insurance

  • The most important benefit of an OPD cover is that it does not require hospitalisation to claim. Hence, this includes treatments for fractures, various necessary dental treatments and minor surgeries.

  • Medical expenses are on a rise, and a comprehensive cover might not be enough for a year’s medical expenses. In the current situation people do not prefer going to a clinic due to Coronavirus, however there is an increasing trend of doctor visits more than hospitalisation.

  • With seasonal diseases and other illnesses due to climate change, people visit doctors for consultations frequently. With this cover, one can make multiple claims within the same year until the limit is exhausted.

  • A few new age insurers are also covering Covid tests, even if they are taken at home, under an OPD cover

Difference between OPD and daycare procedures

The primary difference between OPD and daycare procedures is that OPD cover does not require hospitalisation. On the other hand, a daycare procedure cover requires hospital admission. OPD refers to all medical treatments and doctor consultations that one may require without having to be admitted at the hospital. In contrast, daycare procedures refer to minor surgeries or other treatments that require one to be admitted to the hospital for less than 24 hours.

Expenses related to OPD might look innocuous; however, when you know that you have made multiple doctor consultations and calculate the total expenses, it might surprise you. wOPD cover helps in reducing the out-of-pocket expenses that are usually ignored by many during a doctor consultation.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.


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health insurance

Vivek Chaturvedi .

The author is Head of Marketing, Digit Insurance

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