Health Insurance that includes OPD Cover
OPD visits don’t require patients to stay in the hospital for over 24 hours or undergo daycare treatment for at least 24 hours. OPD covers routine doctor visits, enabling the insured to claim expenses up to the policy’s specified limit. It covers medical consultations with general physicians, dentists, pediatricians, specialists, orthopedics, and other necessary healthcare providers, depending on the policyholder’s needs.
What is OPD Cover?
An OPD cover is a health insurance benefit that pays for outpatient treatment costs. It ensures that the insurance provider covers the insured’s medical expenses without requiring hospitalization. Since most health insurance plans don’t include OPD coverage, it is typically available as an add-on.
Some health insurance companies in India offer OPD insurance cover as part of their basic plans. Explore the details of OPD health insurance plans, including their coverage benefits and features.
OPD Coverage Health Insurance Plans for 2024
Explore the table below featuring various health insurance plans with OPD coverage from different insurers in India:
| OPD Health Insurance Plan | Sum Insured (Rs.) | Entry Age Criteria (yrs.) | OPD Cover |
|---|---|---|---|
| Bajaj Allianz Tax Gain | N/A | 18 - 75 years | OPD hospitalization expenses under a single policy |
| Aditya Birla Activ Health Enhanced Platinum Plan | Rs 2 lakh - Rs 2 Crores | Min - 5 years in individual plan Min- 91 days in family floater |
OPD Limit - Rs 5000 to Rs 20,000 |
| Cholamandalam Family Healthline Plan | Rs 2 lakh - Rs 15 lakh | 18-65 years | N/A |
| Bharti AXA Health AdvantEdge | Rs 2 lakh - Rs 3 Crores | N/A | Optional OPD Cover |
| Digit Health Care Plus OPD Insurance Plan | Rs 10,000 - Rs 3 Crores | 18 - 65 years | Wider Coverage |
| Care Family Health Insurance Plan | Rs 3 lakh - Rs 6 lakh | 91 days and above | Optional OPD Cover Rs 5,000 to Rs 50,000 |
| Star Outpatient Care Health Insurance Plan | Rs 25,000 - Rs 1 Lakh | 18 - 50 years | OPD cover at all Network facilities |
| SBI Arogya Plus Plan | Rs 1 lakh - Rs 3 lakh | 1 - 65 years | OPD Consultation/Treatment Cover |
| Niva Bupa Go Active Health Plan | Rs 4 lakh - Rs 25 lakh | N/A | Up to 10 Cashless OPD Consultations |
Benefits of Covering OPD Expenses in Health Insurance
Health insurance plans that include outpatient department coverage offer the following benefits to policyholders:
- It benefits patients who need frequent hospital visits for OPD consultations, even for common issues like viral fever.
- The insured can be reimbursed for substantial pharmacy bills.
- OPD coverage benefits patients with pre-existing medical conditions that frequently require medical consultations.
- Immunocompromised individuals may also benefit from OPD health coverage.
- People with chronic conditions like asthma, diabetes, arthritis, or thyroid issues, who need regular doctor consultations, can benefit from OPD coverage.
Note: OPD consultations are covered only at in-network hospitals and clinics.
Which OPD Health Insurance Plan Should You Buy?
Explore the details of health insurance plans with OPD coverage below:
Bajaj Allianz Tax Gain Health Insurance Plan with OPD Cover
Anyone between 18 and 75 can purchase the Bajaj Allianz Tax Gain health insurance policy. This family floater plan covers both outpatient (OPD) expenses and hospitalization costs under one policy.
Under the Tax Gain Plan, the policyholder can file claims for dental procedures, spectacles, dentures, and crutches. For cashless services, it provides access to over 6,500 hospitals across India.
Aditya Birla Activ Health Enhanced Platinum Plan
The Aditya Birla Activ Health Enhanced Platinum Plan covers dental consultations and investigations, with sum insured amounts ranging from ₹2 lakh to ₹2 crore. The policy is available on both an individual and family floater basis.
The policy covers general physician or specialist visits at 10% of the OPD limit per visit, and it covers medicines and diagnostics at 50% of the OPD limit.
Cholamandalam Family Healthline Plan
Chola Healthline is a comprehensive family insurance policy that offers health coverage for families on both an individual and floater basis. You can also add OPD coverage to this family health plan by paying an additional premium. This add-on includes coverage for dental expenses, hearing aids, contact lenses, spectacles, and more.
Bharti AXA Health AdvantEdge Plan
The Bharti AXA Health AdvantEdge policy provides OPD cover for both dental and medical expenses. This OPD coverage is available in both the Royal and Apex variants of the plan. The coverage is capped at 0.5% of the sum insured or a maximum of ₹1 lakh, whichever is lower.
This plan covers outpatient expenses including in-network pharmacy, doctor consultations, diagnostic tests, and physiotherapy. The sum insured for the Bharti AXA Health AdvantEdge Royal Plan ranges from ₹5 lakh to ₹50 lakh, while the Apex variant offers coverage from ₹75 lakh to ₹3 crore.
Digit Care plus OPD Insurance Plan
Digit Care Plus is an OPD insurance plan designed to cover outpatient treatment expenses incurred by the insured during the policy term. This plan allows claims for medical consultations and examinations, diagnostic fees, medicine bills, surgical treatments, dental care, hearing aids, and more. Additionally, the policy covers COVID-19 hospitalization expenses.
Niva Bupa Go Activ Health Plan
The Niva Bupa GoActive Health Insurance Plan provides cashless OPD coverage benefits. It helps policyholders save money spent on regular hospital visits, with OPD coverage included in the base premium.
SBI Arogya Plus Health Insurance Plan
The SBI Arogya Plus policy covers hospitalization expenses up to the sum insured, which can be ₹1 lakh, ₹2 lakh, or ₹3 lakh. The OPD sum insured is determined by factors like family type, age, and premium. Maternity expenses are also covered within the OPD limits. A unique benefit of this plan is coverage for HIV/AIDS up to ₹50,000, along with mental illness, genetic disorders, and internal congenital diseases.
Star Outpatient Care Health Insurance Plan
This health insurance plan covers outpatient consultation expenses at any network medical facility in India. OPD claims under this plan are allowed for diagnostics, dental treatments, ophthalmic care, non-allopathic treatments, physiotherapy, and pharmacy expenses.
Inclusions under OPD Health Insurance Plans
The policyholder is eligible for the following coverage benefits under health insurance plans with OPD coverage:
The inclusions of our OPD cover are listed below:
- Pharmacy expenses
- Investigative Test
- Doctor Consultation
- Diagnostic Test
It acts as a safety net for your savings, allowing you to begin treatment promptly without worrying about minor expenses.