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  • What is OPD Expenses Cover in Health Insurance?

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    What is OPD Cover?

    OPD or Out Patient Department cover is a new feature offered as a part of the health insurance policies from insurance providers such as Apollo Munich, ICICI Lombard, Bajaj Allianz and Cigna TTK. Most health insurance providers only cover hospitalization expenses and this limits the scope of cover for Out Patient Department expenses. These expenses include doctor’s consultation fees, health check-ups, pharmacy bills, dental treatment, diagnostic tests, etc.

    OPD-Expense-Coverage

    Why one should Buy Health Insurance with OPD Coverage?

    • Health Insurance plans that offer OPD cover assists the insured to claim expenses other than that incurred during hospitalization.
    • Compared to regular health insurance policies, there are more tax benefits associated with these plans. Policyholders can claim tax exemption on the premium paid for such health insurance policies. There is no Tax Deductible at Source (TDS) for claims.
    • In most health insurance policies with OPD cover, the insured can claim reimbursement on expenses multiple times during the policy period. Out Patient Health Services include a huge number of services and hence more transactions. This makes the monetary value of a health insurance policy with OPD cover higher than that of a regular health insurance policy.
    • This policy also covers pharmacy bills and thereby assist those who have more expenses from the same.
    • Regular health insurance policies determine claims and sum assured based on 24 hours hospitalization. Under the OPD Cover, the sum assured is based on the age of the insured.
    • OPD expenses can be claimed within 90 days of availing the health insurance policy

    Top Companies offering OPD (Out Patient Department) Cover:

    Insurer and Plan Name Overview Features Link to Plan Details
    Bajaj Allianz Tax Gain Plan This is a family floater health insurance policy offered by Bajaj Allianz that covers hospitalization expenses as well as OPD expenses.
    • It offers great tax benefits to the policy holder, as provided under Section 80D of the Income Tax.
    • The Tax Gain plan offers the insured cashless facility through 5000+ network hospitals in India.
    • Out Patient Department expenses can be claimed quickly and easily.
    • The expenses covered include cost of dentures, spectacles, crutches, dental treatment, dental procedures, etc.
    • This plan also covers up to Rs. 1,000 as ambulance charges.
    Get more details here
    Apollo Munich Maxima Plan Apollo Munich offers the Maxima Health Insurance plan that covers Out Patient Department expenses as well. It offers cashless facility for OPD expenses from authorized diagnostic centers, pharmacies, dental care centers and optical care centers.
    • The minimum age for entry is 91 days and the maximum age for entry is 65 years.
    • Premium on the policy will be determined based on the age of the insured and if the policy is taken for a family, the age of the eldest insured member is considered to determine the premium.
    • This policy also covers dental treatment and procedures, cost of eyewear, contact lenses, hearing aids, etc. Individuals or families can avail a Maxima Health Insurance plan and avail its benefits.
    • Outpatient benefits under this plan include doctor’s consultation, pharmacy expenses, specialist services (for certain dental treatments, spectacles and contact lenses only), cost incurred for diagnostic tests, health check-up benefits for the insured who is more than 18 years old.
    • Maternity benefits include cover for expenses incurred before and after childbirth.
    • If the Out Patient treatment cover is not utilized during a policy year, 50% of the same will be carried forward to the next policy period.
    Get more details here
    Max Bupa Heartbeat Platinum Plan Max Bupa Heartbeat Platinum Plan, is a comprehensive individual/ family floater plan that offers a minimum sum insured worth Rs.15, 00,000. For OPD claims made under this policy, the maximum limit is Rs. 30,000.
    • Maternity benefits include cover for expenses incurred before and after childbirth, cover for the newborn, vaccinations during the first year, child care cover, etc.
    • This policy does not place a restriction on the age of entry, i.e., there is no minimum/ maximum age for entry.
    • If the Out Patient treatment cover is not utilized during a policy year, 80% of the same will be carried forward to the next policy period.
    • The age of the eldest insured member in the family is considered to determine the premium.
    • This policy also offers great tax benefits to the policy holder, as provided under Section 80D of the Income Tax.
    Get more details here
    Cigna TTK ProHealth Accumulate Plan The Cigna TTK ProHealth Accumulate Plan offers OPD cover for outpatient treatment, optical care, dental treatment, consultation fees, pharmacy bills, and so on. This policy comes with a “Personal Health Wallet” in which policyholders can keep the funds they have accumulated and use it to pay for OPD expenses.
    • The base cover offered under this policy offers a cover worth Rs. 5, 50,000 – Rs. 25, 00,000.
    • The Cigna TTK ProHealth Accumulate Plan is the personal health wallet benefit option for amounts worth Rs. 20,000, Rs. 15,000, Rs. 10,000 and Rs. 5,000.
    • The money accumulated in the wallet does not expire due to non-utilization.
    • This amount is carried forward when the policy is renewed.
    • The policyholder can also avail an additional benefit of 5% hike on the amount available in the wallet.
    • You can also avail reward points by participating in wellness programs and this can then be used to add funds to the wallet or can be adjusted against your premium.
    Get more details here

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    OPD Expenses and Health Insurance Reviews

  • Page 1 of 50 1 2 3 4 5
    • HDFC Ergo Health Insurance
      "GOOD"
      0.5 4.0/5 "Great!"
      I have been using with the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past one year and i have paid the premium of 24k for this health insurance. They have provided me with the 12lakhs as medical coverage for my complete family.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 16, 2018
    • Religare Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy from the Religare Insurance company. I am paying a premium for a per year. I do not have any claim experience with this policy. Overall it has been a smooth experience with the policy so far. I'll have to wait and see how they respond to my request in future.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "GOOD SERVICE"
      0.5 5.0/5 "Blown Away!"
      I am using the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past two years where i have no claim experience with this policy also added on that the premium i pay seven thousand rupees per year. The medical coverage is for six lakhs for complete family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "GOOD SERVICE"
      0.5 5.0/5 "Blown Away!"
      I am using the health insurance policy with the HDFC ERGO GENERAL INSURANCE from past two years where i have no claim experience with this policy also added on that the premium i pay seven thousand rupees per year. The medical coverage is for six lakhs for complete family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 16, 2018
    • Religare Health Insurance
      "Necessary policy for all family"
      0.5 4.0/5 "Great!"
      I have no claim experience with Religare health insurance policy. I have purchased the policy 1 month before. They have offered me a coverage value of 5 lakhs. I have taken the policy for my family. I have no idea about the list of hospital. They are providing the cashless facility. I pay the premium of Rs. 11700.
      Was this review helpful? 0
      , faridabad
      Reviewed on Nov 16, 2018
    • review Health Insurance
      "Health insurance"
      0.5 4.0/5 "Great!"
      I have been holding the health insurance with Bharti AXA. My total family has been covered in this policy. They have given a coverage of 3 lakhs. The preety much hospitals has been covered in my location. My company has provided this policy around 6 months before. Since its a corporate policy, they have provided only to the employees.
      Was this review helpful? 1
      , mumbai
      Reviewed on Nov 16, 2018
    • Apollo Munich Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Apollo Munich, this policy cover accident claim and there customer support team have explain me about this policy and the premium i pay 25,000-30,000 per year it nominal, i pay through on line, till now there service was good.
      Was this review helpful? 0
      , noida
      Reviewed on Nov 16, 2018
    • Star Health Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Star health insurance, the premium i use to pay is up to 13,000 a per year its nominal for me, from past 1 year i have been using this insurance there customer service explain me about policy and i use to pay through on line like they use to send me the link i use to pay it.
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "EXCELLENT"
      0.5 5.0/5 "Blown Away!"
      I have been using my health insurance policy with the HDFC ERGO GENERAL INSURANCE and the premium i am paying six hundred and thirty five rupees per month also it gives the coverage up to one crore rupees. It is a corporate policy, i am using from past 10 years but i had no claim experience.
      Was this review helpful? 0
      , bhubaneshwar
      Reviewed on Nov 16, 2018
    • Cigna TTK Health Insurance
      "Average"
      0.5 4.0/5 "Great!"
      I have chosen Health insurance with Cigna TTK. They provided me a cashless facility and reimbursement for my doctor bills. I have taken the policy for my entire family. I pay yearly 10K as a premium through ECS. The claim experience is excellent and the reimbursement was immediate. The policy coverage for me is 5L and rest of family members is 3L. They have more network of hospitals but they pay more attention on the medical bills.
      Was this review helpful? 0
      , thane
      Reviewed on Nov 15, 2018
    • Apollo Munich Health Insurance
      "Excellent"
      0.5 5.0/5 "Blown Away!"
      I had a health insurance for my family with Apollo Munich. My experience is good. Due to some reason, I was unable to pay the premium. The policy has been lapsed. I have paid 12K for a year. The payment mode is net banking. The policy coverage was 5L. It was covering almost all diseases, If I use even 5L at one time again they will provide 5L which was very good.
      Was this review helpful? 0
      , new delhi
      Reviewed on Nov 15, 2018
    • HDFC Ergo Health Insurance
      "Average service"
      0.5 3.0/5 "Satisfactory"
      I have been using HDFC ERGO health insurance for while , I never had any claim experience with the policy. I will have to wait and see how they respond to their claim requests in future, overall service was good it cover accidental policy and they charge nominal premium amount.
      Was this review helpful? 0
      , anantapur
      Reviewed on Nov 15, 2018
    • Star Health Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have been using my health insurance with Star health insurance,there premium they charge is nominal only i use to pay my premium amount on monthly bases and it use to get auto debited with my bank account and they have explain me all policy which is cover in this policy clearly, till now i did not face any issue with this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 15, 2018
    • Star Health Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have been holding my salary account from STANDARD CHARTERED bank there service is very good they provide me they don't charge me unnecessarily and they use to update me time to time about this offers. There use to serve me 24/7 whenever i call they assist me very well.
      Was this review helpful? 0
      , chennai
      Reviewed on Nov 15, 2018
    • Reliance General Health Insurance
      "Good Policy"
      0.5 5.0/5 "Blown Away!"
      I have a company provided health insurance with Reliance, i am not aware of the premium amount as my company pays it. There was no claim experience so far with this insurance policy. This policy has a coverage value of Rs 4 lacs.
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 15, 2018
    • ICICI Lombard Health Insurance
      "Good service"
      0.5 4.0/5 "Great!"
      I have been holding my health insurance with ICICI lombard from past 1 year, the premium i pay on yearly bases up to 9000 rupees it was nominal for me and i use to pay through on line and there customer service was good they explained me all policy clearly.
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Nov 15, 2018
    • review Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have taken my health insurance with IFFCO TOKIYO , i dont pay premium the company directly pay on my behalf so i dont know how much i need to pay insurance and this insurance include accidental policy and it has got tie up with various hospitals.
      Was this review helpful? 0
      , dariba
      Reviewed on Nov 14, 2018
    • ICICI Lombard Health Insurance
      "Good card"
      0.5 4.0/5 "Great!"
      I have taken my health insurance with ICICI LOMBARD , i pay premium on monthly bases and till now i have not utilized this insurance ye so i have no idea how it will work and i use to my premium through on line and so far service was good.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 14, 2018
    • Religare Health Insurance
      "Good Coverage"
      0.5 4.0/5 "Great!"
      I have taken health insurance through online portal, the medical value is fine. They gave me Rs. 5 lakhs for health coverage. The service is good the documentation process was very smooth and I got my card on time. Religare health is providing cash less hospital because they have good networks.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 14, 2018
    • HDFC Ergo Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have taken my health insurance with HDFC ERGO , i have not opt there policy yet and i use to pay premium on monthly bases up to 400 rupees and it use to get auto debit from my account and while i applied for health insurance customer service had explained me about all procedure , so far the process went smoothly and it good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 14, 2018
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