What is the OPD Expense Cover in Health Insurance?

Health emergencies are uncertain. They strike at most inopportune times and disturb not only mental butyour financial well-being. However, not all treatments require hospitalisation. With the advancement of medical technology, consultations, diagnosis, and even treatment can be carried expeditiously. You need not spend a single day in the hospital and yet avail the necessary treatment. These procedures are called OPD treatment in the health insurance jargon.

What is OPD treatment?

Your medical treatment is not limited to hospitalisation, but instead, covers diagnostics, check-up, post-surgery consultation and more. The treatments are availed on the advice of a doctor or medical practitioner by visiting their clinic or a multispecialty hospital. The most important thing to note is that OPD treatments do not require the patient to get admitted to a hospital.

What is included in OPD expense cover in health insurance plans?

In recent years, studies show that over 62% of the treatment costs in the country are in the form of OPD expenses. The benefits under OPD cover are available differently under different health insurance plans and policies. Fees for consultation and examination by a medical professional are included under such cover. Moreover, diagnostic procedures like X-ray, brain and body scans, pathology for diagnostics are also included under OPD cover. Additionally, minor surgical procedures, dressings in case of accidents and animal bites are included.

What is excluded from OPD expense cover?

While purchasing a new policy, make sure to make a note of the inclusions under your policy. There may be some day-care procedures that are excluded under some policies, whereas the other plans may include them. General exclusion from the OPD cover includes cosmetic procedures, spectacles, contact lenses, physiotherapy, and ambulatory devices like walkers, BP monitors, glucometers, thermometers, dietician fees, vitamins and supplements.

Often OPD cover is available for purchase as an add-on to your individual health covers or family health insurance. Also, since these plans are more likely to be utilised, the coverage is available at premium prices. It would be best if you analysed the efficacy justifies the cost of such additional coverage while purchasing one.

Who should opt for an OPD cover?

An OPD cover can come handy for anyone and everyone seeking health insurance. This additional policy coverage can be useful to address the treatments that otherwise do not require you get admitted to a hospital. Older people often require medical attention due to their increased age. At such times, health insurance for senior citizens with OPD coverage is helpful to take care of these medical procedures that are required on an ongoing basis. Chronic conditions that require frequent visits to the doctor can also be addressed using an OPD expense cover.

Most OPD treatments are considered only in a network hospital and clinics. There may be almost none to very less waiting period to avail OPD treatment. For a pre-existing disease, the OPD cover is generally available as early as 90 days from purchase of the policy and for an ailment not related to pre-existing one, it can be available as early as from the first day. These specifications may differ based on the terms and conditions of the policy.

To conclude, these small treatments can amount to a huge bill when aggregate, and it is beneficial to avail an OPD expense cover.