Having a health insurance plans actually improves one’s financial health during uncertainties.
Navneet Dubey

An Out-Patient Department cover, commonly known as OPD cover, is one of the categories of health insurance that opens up an entirely new and unexplored section of the customers for insurance companies. Insurers have recently started experimenting with OPD insurance by adding it as a feature in their health insurance indemnity plans as lifestyle-related health issues is increasingly driving people to doctors for even smaller medical interventions.

Also, there are no preconditions to get an OPD cover with the health insurance policy. If the insurance company agrees to underwrite a profile, the person will automatically get an OPD cover with the policy. The terms and conditions related to pre-existing diseases remain same, whether you buy health insurance with an OPD cover or without an OPD cover.

Jyoti Punja, Chief Customer Officer, Cigna TTK Health Insurance said, out of total health expenditure approximately 60 percent is attributed to the ambulance, prescribed and OTC medicine, diagnostic, laboratory, and preventive care charges which mainly constitute out of pocket expenses.

“Given these facts, it is best to create a financing mechanism for the Out Patient Expenses (OPD) to take care of pharmacy, diagnostics and preventive care expenses which otherwise is not covered under in-patient health insurance cover. These are substantial medical expenses, therefore it is advisable to have a mechanism to fund preventive care that will ease your financial burden when there is health related expense such as hospitalization, OPD expenses amongst others,” she said.

Right from small check-ups to complete treatments, health insurance with an OPD cover plays a vital role when it comes to saving medical costs during an emergency. Having a health insurance plan actually improves one’s financial health during uncertainties.

Dhruv Sarin, Director, Policybazaar.com said in today’s scenario, a single doctor visit can cost around Rs 1,000- Rs 1,500. In this scenario, if you have an OPD cover then that can bring relief to your pocket. “If you have an OPD cover you can claim doctor ‘consultation fees, pharmacy and health check-up bills up to the pre-described limit in the policy. However, one must closely look at the parameters or what is covered under an OPD plan. Some insurance companies only allow dental or optical treatment under OPD cover whereas all the OPD expenses are covered under certain plans. Accordingly, there will be a difference in the premium, depending on the reimbursement amount and coverage particulars,” he added.

Below table will help understand the premium rates with or without OPD plans:

Plans with an OPD Cover- A Family Floater Plan for Self 30 Years, Spouse 30 Years, Living in a metro city with no pre-medical condition, Sum Insured 5 Lakhs.

Plans without OPD Cover A Family Floater Plan for Self 30 Years, Spouse 30 Years, Living in a metro city with no pre-medical condition, Sum Insured 5 Lakhs.