How OPD Works in Health Insurance Policies

OPD Coverage in Health Insurance Explained

OPD stands for Outpatient Department in health insurance, which covers the expenditure incurred by a patient outside hospitalisation. This type of coverage is helpful for diagnostic tests, pharmacy bills, and minor medical procedures that do not involve an overnight stay in the hospital. OPD is important for balancing routine healthcare expenditures and ensuring that healthcare is affordable and accessible for you.

How Does OPD Coverage Work?

OPD benefits under the health insurance policy allow a policyholder to claim refunds of medical expenses that have been incurred without hospitalisation. Many health insurance policies also provide cashless facilities for the OPD treatments availed from network hospitals or clinics. 

The policy splits the sum insured into sub-limit, which differs from the main hospitalisation sum insured. For instance, if an overall sum insured under any policy is Rs. 5,00,000, then that can provide Rs. 10,000 to Rs. 25,000 to OPD.

Benefits of OPD

• General Doctor Consultation :  OPD will pay for the charges of visiting a general physician and a specialist. Regular check-ups or visiting a specialist need not require hospitalisation. OPD also includes the costs for diagnostic tests like blood tests, X-rays, MRI, etc. It is quite useful for chronic patients, as they may require frequent tests. 

It also covers outpatient visits and prescribed medicines. OPD benefits reduce the cost of obtaining medications for minor illnesses or for chronic treatment.

• Minor Surgical Procedures : Minor surgical procedures, which do not require hospitalisation such as wound dressing, physiotherapy, or other minor dental work, may be covered.

Why do You Need an OPD Coverage?

• Routine Medical Treatment: OPD benefits will be suitable for anyone needing routine medical treatment.
• Cost savings: Doctor visits, diagnostic tests, and drug purchases can be very costly. OPD benefits can save one from recurring costs.
• Tax benefit: The premium paid on health insurance policies, which may have OPD benefits, is allowed as a deduction under Section 80D of the Income Tax Act.

Things to Remember

• Sub-Limits and Caps: Most OPDs have sub-limits or yearly caps, which means that the policyholder will only get back the amount up to this.
• Waiting Period: Some OPD benefits might also come with a waiting period before it starts. It usually ranges between three months to one year.
• Network Limitation: Cashless OPD might also be restricted to a certain list of hospitals or clinics, so check the list.

If you want comprehensive health insurance, Star Health is there with plans that include benefits of OPD covering daily medical expenditure. With cashless services and an extensive network of hospitals. Star Health ensures you stay covered in not only in-patient care but also in out-patient care. 

Also Read:

→ How Soon After Taking Out Health Insurance Can I Claim

→ How To Buy Health Insurance

→ How to Check Health Insurance Policy Details

→ How To Choose the Best Health Insurance

→ How to Claim Health Insurance