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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

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  • United India Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I got group insurance from company, on time I got policy. My father was not good at the time I have used the policy. I got the reimbursement around Rs. 23,000 the total value is Rs. 33,000. I went to shobha hospital they don't have tie up with United India, hence I got the reimbursement.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • Max Bupa Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I have medical cover with Max bupa, they gave me the coverage value of Rs. 5 lakhs its covers for entire family. One time I claimed for my mother for the eye surgery, I got the reimbursed within 30 days with 90% of amount, the total experience was good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 18, 2019
  • New India Health Insurance
    "Yet to experience the policy"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health insurance policy from new India. As per company norms, they have given me a coverage value of Rs. 5 lakhs. My entire family has been covered in this policy. They are offering a cashless treatment facility.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • United India Health Insurance
    "Very Good Service"
    0.5 4.0/5 "Great!"
    I had taken this insurance policy in the year of 2018 and the the premium has been deducting from my salary. The premium amount has not been too high and there has been many hospitals collaborated within my locality. There has also been some cashless treatment available with this policy as well.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 17, 2019
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have my health insurance with Star health insurance, i had claim experience with it, my experience was good, they have good tie up with my hospital and they have mailed me about the location of it, and i am happy with there service, they have charged me premium amount on yearly basis, and the premium amount is nominal for me, and i use to pay through on line mode.
    Was this review helpful? 2
    , chennai
    Reviewed on Jan 17, 2019
  • Max Bupa Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Max BUPA , i have not opt there policy yet and i use to pay premium on monthly bases , 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
    , new delhi
    Reviewed on Jan 17, 2019
  • Max Bupa Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with Max bupa health insurance, there service is good, they have charged me premium nominal ,and the premium is on yearly basis, and they have tie up with many hospital , and had shared the details via mail, and i pay premium amount through on line mode.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 17, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with HDFC Ergo, they got tie up with many hospitals, and they have shared me location on those hospital in mail, and they have charged me nominal premium amount ,they have charged me up to 17000-18000 as premium, it is on yearly basis, and i use to pay the premium on an on line basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 17, 2019
  • SBI General Health Insurance
    "Bad experience"
    0.5 1.0/5 "Really Bad"
    I got the health insurance with SBI, they got tie up with many hospitals. I Felt the medical cover its less and i am not happy with there support team ,like if i want to call the customer care there number would not be reachable and they use to mail me PDF after paying premium amount,it would not get open, they have charged me premium amount on yearly basis,i have bad experience with this bank.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 16, 2019
  • HDFC Ergo Health Insurance
    "Very good benefits"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance from HDFC ERGO which was purchased by me in the year of 2018 because the benefits are very good. The claim process was simple and they have more number of hospitals for cashless. I have paid 18,800 for one year and took 3 years policy for myself and my wife. The medical coverage is 10L for myself and 5L for wife.
    Was this review helpful? 2
    , bangalore
    Reviewed on Jan 14, 2019
  • HDFC Ergo Health Insurance
    "Good"
    0.5 3.0/5 "Satisfactory"
    I have taken health insurance from HDFC Ergo which was offered along my personal loan. I have received the insurance paper and its been couple of months. It covers critical illness and need to go through the policy benefits. Always the customer is good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 14, 2019
  • Tata AIG Health Insurance
    "Great company"
    0.5 5.0/5 "Blown Away!"
    I have taken health insurance from tata aig. I did take health insurance from tata aig for my parents and The Process was so simple. Customer representative is good. The customer service and response was on time, never had any issues. Now I feel safe for my family Thank you tata aig.
    Was this review helpful? 1
    , solapur
    Reviewed on Jan 12, 2019
  • ICICI Lombard Health Insurance
    "Good Health insurance provider"
    0.5 3.5/5 "Pretty good"
    This policy was part of my employment, I took the medical coverage of Rs. 5 lakhs for the tenure of one year, this medical benefits for my entire. They have good networks of hospital with major disease cover. But I think it doesn't have no claim bonus.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 11, 2019
  • Reliance General Health Insurance
    "On time approval with reliance"
    0.5 4.0/5 "Great!"
    For my spouse operation I used the health policy, I approached them for the claim through hospital. I submitted the form and they send the papers to the Reliance insurance company. I got the cash less treatment, but I paid some amount which was not covered. But they gave me the on time approval.
    Was this review helpful? 1
    , kolkata
    Reviewed on Jan 11, 2019
  • Cigna TTK Health Insurance
    "On time service"
    0.5 5.0/5 "Blown Away!"
    On time Cigna TTK have activated the policy which provided by the company, the policy which I hold it has the coverage of Rs. 4 lakhs its covers for me. They are providing coverage for the pre existing with the tax benefits but there is no claim.
    Was this review helpful? 1
    , dandeli
    Reviewed on Jan 10, 2019
  • Cigna TTK Health Insurance
    "Its Good"
    0.5 5.0/5 "Blown Away!"
    In Cigna TTK, they are providing pre existing disease cover, but they don't have no claim bonus features. The response is good they have good customer care working 24/7 , the medical coverage is good for me and entire family. They have many hospital which they got tie up in Mumbai.
    Was this review helpful? 0
    , mumbai
    Reviewed on Jan 10, 2019
  • Apollo Munich Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I had taken this insurance policy a while back and i had been paying the premium amount on an annual basis. The premium method has been convenient and the premium amount has not been high. There has been many hospitals covered in my locality and their customer support has also been helpful.
    Was this review helpful? 2
    , pune
    Reviewed on Jan 09, 2019
  • ICICI Lombard Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    My organization has provided me a health insurance with ICICI Lombard. I have not claimed anything from this policy. My entire family has been covered in this policy. They have given me a coverage value of Rs. 3 lakhs. This is a cashless policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 09, 2019
  • Star Health Health Insurance
    "Good"
    0.5 4.0/5 "Great!"
    My company has offered a health insurance from Star Health with the coverage of 1L, its for the family, Still I have not used the policy and am gone utilize the policy within 15 days for my family.They covers a major disease. I have called the customer service and the response is good. I am planning to go for reimbursement, they do have minor network of hospitals for cashless. I can recommend after completing my claim.
    Was this review helpful? 1
    , chennai
    Reviewed on Jan 09, 2019
  • National Insurance Health Insurance
    "Good"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health policy from National insurance with the coverage of 2L. It is for the family members and no claim. I never contacted the customer service. Every year it was renewed by the company. They have limited networks of hospitals for cashless. It does not cover only eye problems, if we got admitted in hospital for 24hrs then applicable for claim.
    Was this review helpful? 0
    , pondicherry
    Reviewed on Jan 09, 2019
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