Is it worth buying hospital OPD insurance?

A health insurance policy is mainly bought to cover the costs of surgery or medical treatment. But not all your hospital visits end in hospitalization or surgery. With the advancement in medical science and the availability of cutting-edge technology, treatment time is cut in half, and you can complete the procedure and walk back home within a day without having to get yourself admitted. Such treatments are called Day Care Treatments. Sometimes a normal visit to the doctor for advise and consultation is also needed. This is referred to as Out Patient Department (OPD), and it is estimated that OPD accounts for 60% of the total healthcare costs in India.

Neha is a 32-year-old professional swimmer and has participated in all the major swimming championships around the world. Though she works for a famous IT company, she makes time out to participate in events worldwide and manages time to handle her professional life and sporting life. Being a swimmer, Neha must manage her physical fitness and follow a strict diet regime regularly. Therefore, she spends at least 4 hours daily in the gym and practices yoga apart from training on the grounds. She has suffered many injuries in this process, such as ligament tears, fractures, bruises, etc. Her coach suggested she get health insurance with OPD cover to secure herself against the regular expenses on outpatient consultations and treatments. Since her health is in top condition, she is not afraid of any significant ailments. If she suffers an injury or needs a checkup before any major swimming event, she visits her doctor’s clinic and gets the necessary treatment or checkup done within a few hours. So, with the help of the OPD claim, she can manage those expenses without burning a hole in her pocket.

What is OPD? 

OPD or Outpatient Department treatment denotes the diagnosis and treatments performed in a clinic or a hospital or even in a doctor’s consulting room, on the advice of a medical practitioner or doctor. If you are thinking of what is OPD in the hospital, it is the general ward inside the hospital, where patients are attended for simple treatments. These procedures usually do not require hospitalization and are completed in a few hours of time. All minor surgeries involving fractures, dressing cuts, etc., fall under OPD.

Health Insurance with OPD Cover

The expenses incurred on an OPD basis are doctor’s consultation fees, pharmacy bills, health checkups, diagnostics tests, etc. These are not covered in a health insurance policy as there is no hospitalization involved. But OPD expenses can quickly grow up to vast amounts throughout visiting the hospital regularly. To address this gap, health insurance plans with OPD coverage are now available to provide OPD treatment reimbursement. They are also called OPD insurance as such insurance plans offer coverage for OPD expenses along with regular insurance coverage on illnesses and ailments.

Health insurance with OPD guarantees protection against all types of medical expenses that include hospitalization or OPD. This ensures you do not worry about the rising medical bills for frequent visits to the doctor on an OPD basis. But, the insurance company may place limits on OPD coverage or sum assured depending on the base health insurance policy.

With drastic lifestyle changes, new age diseases that include headaches, sinus, asthma, allergies, digestion problems, etc., are rising. Mostly, these are treated on an outpatient basis by a duty doctor in their consulting room or dedicated outpatient wards. By availing of a health insurance policy with OPD cover, these out-of-pocket expenses are taken care of without feeling any financial burden.

Why you should buy OPD Insurance?

While a health insurance policy is necessary to safeguard yourself from significant health complications, an OPD cover is helpful if you are suffering from any chronic disease or in a profession that makes you prone to injuries requiring frequent OPD visits.

The cost of availing a health insurance policy with OPD cover is also higher as the premium for OPD insurance is more than the standard health insurance policy. So unless there is a specific need for you to take up a health plan with OPD cover, it is better to continue with your standard health insurance policy. To make it even more straightforward, the following categories of people may require dedicated OPD coverage.

• Young generation: Individuals within the age of 25 to 40 years who don’t fall under the high-risk group and may not use hospitalization more compared to OPD.
• Sportspersons and fitness individuals are prone to get injured regularly.
• Senior citizens visiting the hospital for preventive health checkups, dental procedures, common consultation, etc.,

Inclusions in OPD: Before availing an OPD insurance, knowing what comes under OPD classification is required.

• Consultations with a doctor in a policy year
• Diagnostic tests, scans, X-rays
• Medical aids such as crutches, wheelchairs, devices, hearing aids. Etc.,
• Minor surgeries, dressing for fractures, wounds, and cuts
• Medical checkups, vaccinations, etc.,

Exclusions in OPD: The following are not covered under the scope of outpatient department (OPD)

• Self-inflicted injuries
• Substance abuse, Self-harm
• Involvement in illegal activities
• Inpatient treatment involving hospitalization
• Naturopathy treatments.
• Cosmetic treatments.
• Dietician consultations
• Physiotherapy sessions

OPD Insurance Plans: Many health insurance plans have launched health insurance policies with OPD coverage to cater to the growing demand for such products. Some of the top OPD insurance plans are given below: 

Top 10 OPD Health Insurance Plans

• ICICI Lombard Complete Health Insurance
• Manipal Cigna Lifetime Health
• Apollo Munich Maxima
• Bajaj Allianz Tax Gain Plan
• Max Bupa Heartbeat
• Aditya Birla Activ Health Enhanced Platinum Plan
• Bharti AXA Health AdvantEdge
• Care Family Health Insurance Plan
• Digit Health Care Plus OPD Insurance Plan
• SBI Arogya Plus Plan

Buying health insurance with OPD coverage is undoubtedly a valuable addition during times of unforeseen circumstances. But do keep in mind that the premium for OPD insurance is significantly higher than a regular health insurance policy. Therefore, analyze whether you require OPD coverage or are better paying for outpatient treatments from your pocket on a per need basis.