OPD Cover in Health Insurance Plans

OPD cover in health insurance means coverage for expenses that you incur towards medical treatment as an outpatient. OPD means an outpatient department, which is reserved for patients who do not require hospitalisation for their treatment.

An OPD cover is the opposite of a traditional medical cover, which includes only hospitalisation and related charges. It covers expenses related to doctor consultation charges, small medical procedures, diagnostic charges, etc., that do not require the patient to stay at the hospital for 24 hours.

With TATA AIG medical insurance with OPD cover, you can get the following benefits.

1.Reduces Expenses- With an OPD cover, there is a reduction in your out-of-pocket expenses, as they are covered under the insurance plan. For example, the TATA AIG Medicare Premier plan offers OPD treatment coverage and OPD dental treatment coverage, providing for various expenses as per the terms of the policy.

2.Covers Charges for Doctor Visits- Doctor consultation charges can be expensive these days, ranging from ₹500 to ₹1500. However, OPD cover includes the doctor's fees, which saves you from spending huge sums on consultation fees for every visit.

3.Pays for Pharmacy Bills- Your OPD cover also includes expenses incurred on pharmacy bills to get the prescribed medicines, including health supplements, vitamin tonics, dietary or medical purpose foods, etc.

4.Coverage for Minor Treatments- It also covers minor procedures that you may have to undergo without hospitalisation. TATA AIG insurance plans and OPD add-on cover provide coverage for minor treatments, such as physiotherapy, dental fillings, tooth extraction, etc.

5.Assists in Managing Chronic Illnesses- Chronic illnesses, such as diabetes, asthma, hypertension, etc., require extensive treatment, tests, doctor visits and medication. Having an OPD cover in health insurance can reduce your spending on treatments. Besides, it also enables you to complete the extensive treatment without worrying about finances.

6.Facilitates Preventive Care- When your insurance plan covers OPD expenses, such as diagnostic tests, doctor visits, etc., it encourages preventive care and allows you to take preventive measures without worrying about the finances.

7.Allows Early Diagnoses and Treatment- Since OPD expenses include medical screening charges, medicine costs, etc., it facilitates early diagnoses of diseases and also enables you to get the required treatment.

For example, the TATA AIG OPD Care add-on cover includes high-end diagnostic charges such as Positron Emission Tomography Magnetic Resonance Imaging (PET MRI), which helps early diagnoses of cancer, enabling early treatment and cure of cancer.

8.Provides Tax Benefits- The premium that you pay towards the add-on cover for OPD insurance can be claimed as a tax deduction. Thus, it also helps you to save taxes while reaping medical benefits.

9.Offers Teleconsultations- TATA AIG OPD Care rider also includes coverage for special and general teleconsultations, if required by the insured. Under this coverage, you can get teleconsultation services with the concerned doctor through digital modes, audio, video, online portals, etc.

Also Read: Health Insurance Add-Ons

Recent studies have shown that OPD treatments have accounted for nearly 62% of total medical expenses in the country compared to hospitalisation expenses. However, you should go for an OPD Health Insurance along with your medical insurance plan in the following cases:

If You Have Chronic Illness

As mentioned above, chronic illnesses, such as asthma, diabetes, arthritis, etc., require frequent doctor visits and extensive treatments, which can burden you financially. Having an OPD cover with your best health insurance policy from TATA AIG is an effective way to get the right treatment without emptying your bank account.

If you are an Elderly Person

If you are an elderly citizen, you should consider opting for an OPD cover along with your health insurance plan, as you may regularly need to visit your doctor for treatments related to minor surgeries, regular check-ups, dental procedures, etc. So, in such cases, your OPD health insurance will provide you with coverage for all your OPD treatments and consultations.

If you have a Weak Immune System

If you have a weak immune system and suffer from illnesses on a frequent basis, you may require regular medical check-ups and doctor visits. In such a case, you must have OPD health insurance plans, as they help to cover the cost of treatment and consultation.

If the Insured is a Child

Children may be more susceptible to illnesses and infections, leading to frequent pediatric visits and high medical costs. Thus, having an OPD cover reduces the financial burden and enables you to give your little ones the best care and treatment.

If you are a Sports Lover

While sports and other outdoor activities are essential for good health, they may also lead to injuries like bruises, sprains and fractures. Hence, OPD health insurance can give you financial protection in such cases. Additionally, medical insurance will also help you with your yearly tax savings plan.

Many insurers offer OPD cover either with their basic insurance plan, or you can also get an add-on cover at an additional premium.

OPD Cover Under Base Health Insurance

When you purchase a health insurance plan, you can benefit from the OPD cover that is included. Some of the benefits of OPD cover under the base health insurance plans include the following:

• Treatment as an outpatient at any hospital.
• It also includes diagnostic charges, such as those incurred on an outpatient basis, including liver biopsy, Brain Perfusion Imaging, and Computed Tomography (CT)- guided biopsy, among others.
• The limit of OPD cover may range from ₹25,000 to ₹50,000, depending on the sum insured, and may vary from one provider to another.
• Some insurers may also offer OPD cover over and above the sum insured amount based on the policy’s terms and conditions
• Your base insurance plan may also offer OPD dental cover for root canal, tooth filling, etc.

OPD Add-On Cover Benefits

If you want a comprehensive OPD cover with your insurance plan, you can choose to include the OPD as an add-on cover to your base insurance plan. Here are the features and benefits of an OPD add-on cover.

• OPD Treatment and Consultation- This includes in-person consultations and diagnostic tests for prevailing diseases.

• OPD Dental- It covers the expenses related to OPD dental treatment as per the terms of the policy, including root canal, filling, crown, pulpectomy, restoration, tooth extraction and therapeutic pulpotomy.

• OPD- Vision Care- It also includes charges incurred for consultation and treatment as an outpatient for vision care. It includes coverage for medically necessary procedures and tests prescribed by the doctor.

• OPD Pharmacy- The rider also includes pharmacy charges related to the purchase of medicines, drugs and medical consumables prescribed for outpatient treatment, OPD-vision care, OPD-dental treatment, teleconsultation-general and speciality.

• High-End Diagnostics- You also get benefits of high-end diagnostics tests such as Brain Perfusion Imaging, Computed Tomography (CT) Guided Biopsy, Computed Tomography (CT)Urography, Digital Subtraction Angiography (DSA), Liver Biopsy, Magnetic Resonance Cholangiography Scan, Renogram, Positron Emission Tomography Computed Tomography (PET CT) and Positron Emission Tomography Magnetic Resonance Imaging (PET MRI)

• OPD Physiotherapy- It also covers expenses related to physiotherapy sessions from a qualified physiotherapist if recommended by the doctor.

• OPD Teleconsultation- You can also avail of teleconsultation benefits through various modes for addressing health-related concerns and to get preventive health care services from a qualified or specialist medical practitioner.

• Medical Device Cover- If you have consulted a doctor in the OPD, the rider also covers expenses you incur to purchase or rent medical devices, such as wheelchairs, walkers, belts, collars, Splints, braces, crutches, walking sticks, air mattresses, etc.

• Doctor consultation charges
• Diagnostic tests
• Investigative tests
• Pharmacy expenses
• OPD treatments, such as stitching, plastering a wound, etc.
• Dental treatments and procedures
• Physiotherapy treatments
• Preventive consultations and check-ups

• OPD claims made within 30 days of purchasing the policy are excluded.
• OPD-related expenses for treatment of pre-existing diseases are excluded until the waiting period.
• Gender reassignment and cosmetic procedures are not covered under OPD.
• Treatment for alcoholism, drug or substance abuse is also excluded.
• The cost of dietary supplements is excluded if not prescribed by a doctor.
• Unproven treatments without documentation.
• Expenses for sterility and fertility-related treatments are outside the scope of OPD cover.
• Maternity and childbirth-related treatments and expenses are not a part of the OPD cover.
• Non-medical exclusions, such as breach of law, nuclear attacks, wars, biological attacks, adventure sports, etc.
• Treatment for congenital anomalies, sexually transmitted diseases, rehabilitation expenses, etc., are excluded.

Also Read: Difference Between OPD and IPD in Health Insurance

OPD and daycare do not fall under inpatient hospitalisation expenses. However, they differ from each other. It is crucial to know their meanings and differences so you can understand their coverage under health insurance plans.

When choosing health insurance with OPD cover or choosing an OPD add-on cover for your health insurance, you must pay close attention to some important factors, as they assist you in making the best choice.

1.Coverage- While choosing an OPD cover, pay attention to the coverage that it offers. For example, you can check if it covers doctor consultations, health check-ups, minor procedures, therapies, etc. A wide coverage means more benefits for you.

2.Waiting Period- Some insurers may have a waiting period clause before providing the benefits of OPD. For example, some insurance plans may require having continuous coverage of 24-36 months before you can get the OPD cover benefits.

3.Exclusions- Pay close attention to the exclusions of the OPD cover, as not everything that you may require is included. For instance, a cosmetic procedure may not be a part of the OPD cover. Being aware of the exclusions saves you from end-of-the-moment surprises.

4.Claim Process- Choose OPD plans that have a simple claim process. A straightforward claim process saves you from unnecessary hassles in the event of a medical emergency.

OPD cover in health insurance offers several benefits to those who do not require hospitalisation but may have to visit the doctor often for treatment. By offering coverage for expenses related to doctor consultations, medicines, diagnostic tests, etc., OPD cover provides financial relief and saves you from incurring huge out-of-pocket expenses.

If you are looking for a health insurance plan with OPD cover, TATA AIG has got you covered. We offer affordable and comprehensive health plans to safeguard your health and wealth. The TATA AIG Medicare Premier health plan provides OPD coverage of up to ₹25,000, covering various expenses as per the terms of the policy.

Besides, you can also opt for our OPD Care add-on cover to avail of wider benefits, such as dental expenses, vision care, pharmacy bills, high-end diagnostic tests and so on. Our insurance plans with OPD cover offer adequate coverage in times of medical inflation, covering the costs of various expenses incurred during outpatient treatments.

We also extend the OPD cover benefits to older people who may need to visit the doctor frequently, given their old age and health concerns. Our TATA AIG Eldercare Plans offer OPD cover for those above 61 years.

Get extensive coverage for yourself and your family with TATA AIG insurance with OPD cover and say goodbye to hefty medical expenses!

Are OPD benefits available only for individual health policies?

No, OPD benefits are also available for family floater plans, critical illness plans and senior citizen insurance plans. You can either choose the base health plans with built-in OPD cover or include an OPD add-on cover as per your requirements.

Why is OPD cover so important?

OPD coverage is important because it covers the medical expenses apart from hospitalisation, such as doctor fees, medicine bills, diagnostic tests, etc. Since the cost of medical treatments in India is increasing day by day, OPD cover offers financial assistance in case of outpatient treatments and charges, which are not usually covered under the base insurance policy.

Can I buy OPD as a standalone policy?

OPD is available with the base insurance plans provided by some insurers. You can also purchase it as an add-on cover to enhance the scope of your existing insurance coverage. However, not many insurers may offer OPD as a standalone policy.