OPD Benefits Under Health Insurance

People purchase health insurance so as to cushion themselves against high cost of medical treatment. Almost all health insurance plans in India offer hospitalization benefits i.e. cover cost of treatment if a person is hospitalized. However, there are instances where the nature of injury or illness, though requiring medical attention, may not necessarily require one to get admitted to the hospital. For example, if a person suffers from minor fracture or is suffering from high fever, he or she may have to get admitted to the hospital. In such cases, health insurance companies usually do not cover the cost of OPD (Out-Patient-Department) treatment.

In this blog, we at Secure Cover discuss OPD benefits that a person can avail under health insurance.

What is OPD treatment?

It refers to those treatments availed by a patient without being admitted to the hospital. These may include getting plaster for a minor fracture, medical check-up in case of fever, diarrhoea and other types of minor infections. In fact, even a person who was earlier admitted to the hospital may require regular hospital visits for check-up after being discharged. Unlike in-patient treatment or hospitalization, the cost of treatment is comparatively low. But, if the treatment prolongs and requires regular check-ups and medication, the overall cost may come out to be very high.
In most developed countries, OPD treatment is covered by health insurance plans which also cover the cost of medication. This was not so in India till a few years back and health insurance plans only covered cost incurred during hospitalisation. However, in tune with global practices, more and more insurance providers are offering OPD benefits.

OPD Benefits offered by Health Insurance Plans

The OPD coverage of health insurance plans offered by health insurance companies in India may include benefits such as:

– Coverage for cost of OPD expenses for dentures, spectacles, crutches, dental treatment or procedure etc.

– Coverage for cost of doctor visits, pharmacy expenses on medicines and medical items, specialist services including second opinion from an expert.

– Coverage for cost of diagnostic tests undertaken for any disease or illness before and after a treatment.

– Coverage for OPD cost of maternity treatment including regular checkups and diagnostic tests before and after childbirth. Plans offering these benefits are Apollo Munich Maxima Plan & Max Bupa HeartBeat Platinum Plan.

– Coverage for newborn care including cost of vaccinations and paediatric checkups.

– Cashless claim settlement for OPD treatment if the treatment is carried out in authorized diagnostic centres, Pharmacies, dental care centres and optical care centres. ( Apollo Munich Maxima Plan)

In case of certain plans like Apollo Munich Maxima Plan and Max Bupa Heartbeat Platinum Plan, if a person does not avail the OPD benefits during the policy year, the unused amount is carried forward to the next year. Health insurance companies may carry forward the OPD cover for 50-80 percent of the un-utilized amount. This is similar to the no-claim bonus that health insurance companies provide to their customers in case no claim is made during the policy period.

Lastly, like any other health insurance plan, those purchasing health plans with OPD cover or add-on plans with the same can avail tax benefits under Section 80D of the Income Tax Act on premium paid for the plan.

In Conclusion

Health insurance plans with OPD benefits is essential as it provides financial support for treatment which might cost less initially but may become large over a period of time. These days, more and more health insurance plans offer OPD benefits which include coverage for medicines and diagnostic tests before and after hospitalization as well as for medical checkups and items used. In case of family floater plans, a person can avail OPD benefits pertaining to pregnancy and maternity care.

Disclaimer: The content of this blog is based on personal research of the writer. Reader’s discretion is advised. Neither Secure Cover nor the writer will be held responsible for any wrongful interpretation of the content of this blog.