While health insurance typically covers hospitalization expenses for severe health conditions, it often does not cover routine check-ups or doctor appointments. Should you consider a health insurance policy that includes outpatient department (OPD) expenses?
OPD treatments, which involve regular hospital visits for ailments, check-ups, or ongoing medication follow-ups, do not require hospitalization. These frequent visits can lead to substantial reimbursement bills, making OPD coverage rare in standard health insurance policies.
Also Read: How to Cancel Health Insurance Policy and Get a Refund (iadvisor.in)
Additionally, OPD expenses do not cover daycare procedures, inpatient treatments, naturopathy treatments, cosmetic treatments, or self-inflicted injuries. OPD coverage can be part of a base health policy or purchased as a separate rider.
Most health insurers cover inpatient and daycare hospitalizations and provide OPD benefits like medicines, consultations, and diagnostic tests during pre-hospitalization (30-90 days) and post-hospitalization (60-180 days) periods. A separate OPD limit may also be available if the health policy includes built-in OPD coverage.
Rakesh Goyal, director of Probus Insurance, mentions, “Health insurance policies offering OPD cover as an add-on charge an extra premium. This add-on covers secondary treatment costs, valuable for those frequently visiting hospitals.” For personalized advice on insurance options, contact iAdvisor for a consultation.
Health insurance with OPD coverage benefits policyholders who need frequent hospital visits, reimburses significant pharmacy bills, and is advantageous for patients with pre-existing conditions requiring regular consultations. It is also beneficial for immuno-compromised individuals and those with chronic conditions like asthma, diabetes, arthritis, and thyroid disease.
Amit Chhabra, head of health and travel insurance at Policybazaar.com, notes, “OPD coverage is available in various individual health policies with sums assured typically between Rs. 5,000 and Rs. 20,000, though some policies offer higher amounts. Some policies have sub-limits for specific treatments like physiotherapy.”
Anyone can purchase OPD health insurance, but it is particularly beneficial for patients requiring regular OPD visits. However, OPD coverage terms and conditions vary by policy and insurer. For example, some policies cover vaccinations, while others restrict the use of specific pharmacies.
Goyal advises, “OPD cover is not usually recommended in a health insurance policy, as OPD costs are generally affordable. However, for individuals with pre-existing conditions, chronic diseases, low immunity, or susceptibility to vector-borne diseases, OPD coverage can provide valuable financial support.” For tailored advice, consider contacting iAdvisor for an insurance consultation.
Policies covering OPD treatment tend to have higher premiums compared to those that do not. For instance, an additional Rs. 5,000-8,000 might be required for an OPD cover of Rs. 10,000-15,000. OPD covers also come with deductibles, making them potentially less valuable due to the high cost relative to the maximum claim and the cumbersome claim process.
“OPD charges are high and frequent, making health insurance plans with OPD coverage more expensive. While a standard health insurance premium might be around Rs. 12,000, the same policy with Rs. 50,000 OPD coverage could cost Rs. 48,000,” says Goyal. Although OPD cover offers valuable benefits, its cost is higher compared to regular health policy premiums. Therefore, it is crucial to assess your and your family’s primary healthcare needs to determine the plan’s value. For a detailed consultation, contact iAdvisor to explore the best insurance options for your needs.