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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 Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with HDFC ERGO from last 2 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance policy. A premium of Rs 6000 has to be paid for this insurance and the coverage value is Rs 3-4 lacs.
      Was this review helpful? 0
      , vadodara
      Reviewed on Sep 17, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I was using the health insurance policy with the Star Health. I am paying a premium of 35K per year. On one occasion I claimed the policy and they were able to reimburse only 75% of the amount claimed which wasn't satisfactory.
      Was this review helpful? 3
      , hyderabad
      Reviewed on Sep 15, 2018
    • Reliance General Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance policy with the Reliance General Insurance. I am paying a premium of 27000 per year. It is for the entire family. There hasn't been any claim experience so far. I will have to wait and see how they respond to my requests in future if I will have any.
      Was this review helpful? 1
      , hyderabad
      Reviewed on Sep 15, 2018
    • New India Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health insurance is with New India Assurance from last 1 year, i am not aware of the premium amount as my company pays it. I have no claim experience so far with this insurance policy and the coverage value is Rs 2 lacs for individual.
      Was this review helpful? 1
      , bangalore
      Reviewed on Sep 14, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 7-8 years, i have no claim experience so far with this insurance policy. I pay a premium of Rs 12000 for this insurance policy and the coverage value is Rs 5 lacs for this policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 12, 2018
    • Cigna TTK Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with CIGNA TTK from last 2 years, i am happy with the coverage value of this insurance policy. I pay a premium of Rs 12000 for this insurance policy. I have no claim experience so far with this insurance and the coverage value of Rs 4.5 lacs.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 12, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with MAX BUPA from last 6 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance and i get no claim bonus every year. The coverage value for this insurance is Rs 15-20 lacs.
      Was this review helpful? 0
      , faridabad
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have recently taken a health insurance policy with ICICI LOMBARD. I have to pay a premium of Rs 15000 on yearly basis. This policy i got it along with the personal loan taken from Fullerton. They gave a coverage of Rs 3 lacs for this insurance policy.
      Was this review helpful? 1
      , rajahmundry
      Reviewed on Sep 12, 2018
    • Star Health Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health is insured with STAR health from last 1year and it is a good policy to use. It is a family policy where the coverage value is Rs 3 lacs per individual. I do not have claim experience with this insurance and i pay a premium of Rs 15000 for this insurance.
      Was this review helpful? 1
      , coimbatore
      Reviewed on Sep 12, 2018
    • Religare Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Religare from last 1.5 years, a premium of Rs 14000 has to be paid for this insurance policy and it is a family coverage. My claim experience was very good and they covered 100%. Coverage value is Rs 5 lacs +5 lacs (auto refill) for this insurance.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Sep 12, 2018
    • Reliance General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Reliance general insurance from last 3 months, i pay a premium of Rs 10000 for 2 individuals and each one has the coverage value of Rs 5 lacs. It is a good policy to use and i have not claimed anything so far from this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold an Individual health insurance policy with National insurance from last 4 years, i have not claimed anything so far from this insurance policy. I pay a premium of Rs 3000 for this insurance policy and the coverage value is Rs 1.5 lacs for this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with HDFC ERGO from last 1.5 months, i am happy with the coverage value of this insurance policy. A premium of Rs 6000 has to be paid for this insurance policy. I have no claim experience with this insurance the coverage value is Rs 5 lacs.
      Was this review helpful? 0
      , palanpur
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Normal Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the ICICI Lombard. I am paying low premium, there hasn't been any claim experience with the policy so far. Considering the premium I pay it has been a normal experience with the policy so far.
      Was this review helpful? 1
      , udaipur
      Reviewed on Sep 11, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard, I am paying the premium and I do not have any claim experience with the policy so far. I'll have to wait and see how they respond to my claim requests in future. It has been a hassle free experience so far.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 11, 2018
    • Star Health Health Insurance
      "Start Health Insurance Fraud"
      0.5 0.5/5 "Unacceptable"
      My father purchased Star health insurance for family safety and was paying premium from last 2 years but when time came insurer refused to give claim stating that throughout the hospitalization and all investigation reports are within normal limits. My brother was admitted in family hospital delhi for 24 hours, doctors diagnosed him and billed approx 13500.
      Was this review helpful? 3
      , new delhi
      Reviewed on Sep 08, 2018
    • Chola Ms Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Cholamandalam health insurance from last 2 years, i am happy with the coverage value of this insurance policy. I am not aware of the premium amount as my company pays it. It is a family coverage and they cover up to Rs 5 lacs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 08, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 3 months, i am happy with the coverage value of this insurance. I am not aware of the premium amount as my company pays it. The coverage value is Rs 10 lacs for accidental policy and Rs 10 lacs for death policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 08, 2018
    • National Insurance Health Insurance
      "Very Good Service"
      0.5 4.0/5 "Great!"
      I had taken this insurance policy almost ten years back and the premium had been paying online. The premium amount has not been higher and it was nominal. Their customer support and their staff responses also had been good as well. They also covers most of the hospitals in our locality.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Sep 07, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have an Individual health insurance policy with ICICI Lombard from last 4 years, i pay a premium of Rs 6500 for this insurance policy. I have not claimed anything so far from this insurance policy. The coverage value for this policy is 7 lacs.
      Was this review helpful? 1
      , faridabad
      Reviewed on Sep 06, 2018
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