OPD Cover in Health Insurance Plans

  • Author :
  • TATA AIG Team
  • Published on :
  • 28/01/2022

The OPD cover refers to the cover plan, along with your health insurance policy, that covers all the OPD charges or outpatient treatment charges. This cover ensures that the policyholder gets financial coverage against all the treatment and consultation charges related to the OPD without hospitalisation. Most of the medical insurance plans do not come with an added OPD cover. Hence, these covers are available as rider plans.

A Few Common OPD Procedures

In general, ear, eye and dental procedures are considered OPD treatments. So, apart from cataract operations, dental scaling and so on, here are a few more common out-patient procedures that you can get coverage for with your OPD cover plan:

-Dermatological Procedure: Your skin procedures can happen without getting admitted to the hospital. For example, laser therapies for reducing scars, wrinkles, etc., and acne removal procedures can be considered as out-patient treatments.

-Nose & Mouth Procedures: A doctor can remote a swelled-up tonsil or treat nose and mouth infections in an outpatient procedure. Tonsillectomy is an OPD procedure where the doctor needs a few hours to remove the tonsil and fix the issue. Even the removal of nasal polyps is a common outpatient procedure.

-Eye Procedures: Ophthalmic (of the eye) procedures such as cataract procedures, glaucoma procedures, chalazion treatment, laser treatments such as photocoagulation, etc. are common ophthalmic OPD procedures.

-Meniscus Procedure: The meniscus is located in the knee, which acts as a shock absorber. A meniscus tear can happen to those who play sports or who exercise regularly in the gym. A surgeon can repair the torn meniscus in an OPD procedure.

OPD Cover with Health Insurance Benefits

OPD Cover in Health Insurance can provide you with the below-mentioned health insurance benefits:

  • You can get financial coverage against regular consultations with your doctor due to something as basic as viral fevers.
  • You can get insured against all the hefty pharmacy bills, diagnostic charges and doctor’s fees.
  • You can get tax exemptions under Section 80D as per the prevailing rules of the Income Tax Act of India.
  • If you suffer from chronic medical conditions like asthma, arthritis, diabetes, etc., and if you need regular consultations from your doctor, you can get benefits from an OPD cover.

Who Should Get Health Insurance Plan with OPD Cover?

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 if:

-You are Between the ages of 20-45: If you opt for health insurance early in age, you will have to pay cheaper premiums. So, even if you think you are young, you should still think about going for an OPD cover in health insurance as you can benefit from the same for something or the other.

-You are a Fitness Freak: Even though you are a fitness enthusiast and probably less likely to get ill, you can still incur workout-related injuries, and hence, an OPD health insurance can give you financial protection in such cases. Additionally, medical insurance will also help you with your yearly tax savings plan.

-You are a Senior Citizen: 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.

Difference Between OPD Treatments and IPD Treatments

The difference between the two is easy to remember. Here’s a simple distinction between OPD (Out-Patient Department) Treatments and IPD (In-Patient Department) Treatments:

Requires hospitalisation of the patients Doesn’t require hospitalisation of the patients
Patients are admitted for proper care and attention at least for 24 hours Requires a visit to a clinic or doctor’s chamber

Why Should You Choose an OPD Cover with Medical Insurance Plans?

OPD expenses can be the reason for financial instability for many. Such treatments can lead to hefty costs that could be difficult to manage for many people in the country. Therefore, to ease your financial woes, it’s better to opt for an OPD cover in health insurance which will act as an umbrella to guard you against all those cumbersome charges for tests, doctor’s consultations, treatments, pharmacy expenses and so on. With a comprehensive OPD health insurance, you can also cover the charges for OPD for yourself and your family members.

How to Choose an OPD Cover for Your Health Insurance Plan?

Here are a few tips to help you choose the best OPD cover in health insurance-

-Check for the Options Available: Once you are ready to opt for an OPD cover for your health insurance plan at an early age, go through the available options online. Then, carry out thorough research about all the options in hand. Always remember, making an informed choice will save you money and time.

-Keep it Affordable: Not all OPD covers have to be expensive to provide you with maximum coverage. So, it’s important to go for a plan that will meet your needs and not burn a hole in your pockets. Budgeting is important before you choose a cover plan. So, it will be a wise decision on your part to go for a reasonably priced health cover to ensure that you can pay the premiums on time.

-Compare Quotes Online: You can compare the OPD health insurance online and go through their quotes to ensure that you opt for a plan that caters to your needs. You can also request a quote online from your chosen insurance providers to understand what will work for you the best. Collect all the quotes, compare health insurance plans and then arrive at a decision.


As you will not find many independent OPD health insurance plans in the market, you should go for an OPD cover along with a health insurance plan that will provide you with additional benefits. Such covers will protect you from the financial burdens of regular doctor visits and minor treatments and protect you against unfortunate accidents and illnesses. Also, keep in mind the above-listed details to be able to reap maximum benefits from your OPD cover and medical insurance plans.

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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