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.
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. |
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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. |
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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. |
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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. |
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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.
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