• 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
    • National Insurance Health Insurance
      "Its good health coverage policy"
      0.5 5.0/5 "Blown Away!"
      National has good hospital facility, they are recommending high profile hospitals with cash less treatment. I make premium around Rs. 4500 per year. Its covers only for me. Medical sum assured Rs. 1.5 lakh, I hope they are providing pre existing disease as well.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 20, 2018
    • HDFC Ergo Health Insurance
      "Good insurance"
      0.5 5.0/5 "Blown Away!"
      My health insurance was offered by the company from HDFC Ergo. The policy coverage was around 3L for annually. They have a good networks of hospitalizations. The customer service was good. I got the insurance papers on time. It is a free policy.
      Was this review helpful? 0
      , chennai
      Reviewed on Feb 20, 2018
    • United India Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I got the UNITED INDIA INSURANCE health insurance policy around 4 months ago. This policy covers 2 members in my family. I have got the medical coverage up to Rs,3,00,000 from this UNITED INDIA INSURANCE health insurance policy. I never got any claim experience with this policy .
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • Max Bupa Health Insurance
      "Good Protection for Health"
      0.5 4.0/5 "Great!"
      Max Bupa gives the medical cover around Rs. 2 lakhs its covers only for me. I paid around Rs. 2500 as premium amount for one year. They do have tie up with good hospital. I hope Max Bupa is providing tax benefits and no claim bonus on the health policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 20, 2018
    • Religare Health Insurance
      "Its Good"
      0.5 4.0/5 "Great!"
      RBL gave me the Health insurance from Religare , without my knowledge they have charged me Rs. 3000 of premium, for the tenure of one year. Religare premium was converted into EMI. Religare gave me the medical cover around Rs. 1.5 lakh with cash less treatment facility and they got tie up around 1000 hospital in India.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 20, 2018
    • Star Health Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I have paid Rs,8000 to get the health insurance policy from the STAR HEALTH & ALLIED INSURANCE company. This policy covers 3 members in my family and it gives the medical coverage of Rs,3,00,000 and I never had any claim experience so far and I have got this policy around 5 months ago.
      Was this review helpful? 0
      , new delhi
      Reviewed on Feb 20, 2018
    • Royal Sundaram Health Insurance
      "Best insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken Health Insurance with Royal sundaram.The premium amount is is 2500,the policy coverage is five lakhs,24 hours hospitalization. for any kind of claims.The payments is done online.I have no claim experience and cashless treatment is covered 95%.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • Bajaj Allianz Health Insurance
      "Best insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken Health insurance with Bajaj allianz,the premium amount is not paid my me as its offered by the company.The policy coverage is six lakhs including the family members.This is covered mediclaim as well as health insurance.The policy was taken two years back and no claim experience.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 20, 2018
    • United India Health Insurance
      "Good policy"
      0.5 3.0/5 "Satisfactory"
      I have taken a health insurance from UNITED INDIA INSURANCE. They provide cashless facility. And i dont have any previous claim experience. Yearly i have to renew the policy. This policy cover my family and myself. They provide cashless facility.
      Was this review helpful? 0
      , secunderabad
      Reviewed on Feb 19, 2018
    • Star Health Health Insurance
      "Better"
      0.5 1.0/5 "Really Bad"
      I am having the health insurance policy with the Star health insurance company. Coverage value is around 3 lakh Rupees. I would like to say that the response is fine one for me with them and the customer service is good.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Feb 17, 2018
    • National Insurance Health Insurance
      "Good"
      0.5 3.0/5 "Satisfactory"
      I am having the health insurance policy with the National Insurance company. I used to talk with them very often and the claim went in easy manner. Everything went in the good aspects with them till now.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 17, 2018
    • Religare Health Insurance
      "Its Best"
      0.5 5.0/5 "Blown Away!"
      I have corporate insurance from Religare Health, I didn't check the benefits, I believe I got medical cover upto Rs. 3 lakhs for my entire family. I got Religare e card. If in case of any emergency if I admit more than 24 hours I can get the reimbursement. I would suggest to enable daily check on insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 16, 2018
    • Bajaj Allianz Health Insurance
      "Good Insurance"
      0.5 5.0/5 "Blown Away!"
      I have taken a Mediclaim plan with Bajaj. I have had a good claim experience with them. They gave the amount pretty easily. Even in case of my relatives experience Baja readily payed about Rs.75000 for the treatment. The number of network hospital in it are pretty good.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 16, 2018
    • Religare Health Insurance
      "Bad Experience"
      0.5 1.0/5 "Really Bad"
      This is my first term with Religare Mediclaim plan. 7 months down my Insurance my Brother had an accident, and consequently they didn't cover me up during this time. I had to pay more than Rs.1 Lakhs for the treatment. I applied for it thrice and all the three times it got rejected, they said accidents aren't covered in this Insurance.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 16, 2018
    • Royal Sundaram Health Insurance
      "Average service"
      0.5 1.0/5 "Really Bad"
      I have taken Royal Sundaram Health Insurance policy,i purchased two months ago,the premium amount is is 6000 paid per annum,I dint receive the kit as yet.The policy coverage is three lakhs and they would cover 100% cashless treatment.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 16, 2018
    • HDFC Ergo Health Insurance
      "Need to improve"
      0.5 1.0/5 "Really Bad"
      I do have the health insurance policy with the HDFC ERGO general insurance company. I would like to say that the customer service could be get improved. I have felt that the response also could be get improved.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 16, 2018
    • United India Health Insurance
      "Very good policy "
      0.5 5.0/5 "Blown Away!"
      I have the corporate health insurance policy wit the UNITED INDIA INSURANCE company. I hold this policy for the past 8 years. This policy covers 4 members in my family. I have the medical coverage amount up to Rs,3,00,000. I would say the cashless treatment option is available with this policy.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 15, 2018
    • Bajaj Allianz Health Insurance
      "Good service"
      0.5 5.0/5 "Blown Away!"
      I have taken a Health Insurance with Bajaj Allianz ,the premium amount is 12,000, its a one time payment.They cover including the dependants the policy coverage amount is five lakhs ,they give 100% for cashless treatment.I pay my premium with my EMI card of bajaj allianz.
      Was this review helpful? 0
      , jaipur
      Reviewed on Feb 15, 2018
    • ICICI Lombard Health Insurance
      "Better service"
      0.5 4.0/5 "Great!"
      I have taken a Health Insurance with ICICI Lombard,the premium amount is 10800 its a one time payment.They cover including the dependants 40% and for the primary holder its 60%they give 100% for cashless treatment.I would say its the best for an individual take a policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Feb 15, 2018
    • Religare Health Insurance
      "Good policy to use"
      0.5 4.0/5 "Great!"
      I hold a health insurance with Religare from last 2 years and it is a good insurance policy. This policy has to be renewed every year and i pay a premium of Rs 11000 for this insurance. I do not have claim experience and i have not taken any cashless treatment. I have a coverage of Rs 5 lakhs which is satisfactory.
      Was this review helpful? 0
      , faridabad
      Reviewed on Feb 14, 2018
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