Benefits of Health Insurance with OPD Cover in India

Visiting a hospital is something that everyone does at least once in their lives, if not for themselves, then for others. However, no one anticipates injuries or illnesses. They are unpredictable and can strike at any time in life. In recent years, medical procedures have seen a substantial increase in treatment cost. Therefore, it is essential to have a financial safety net. And what’s better than having a health insurance plan as a safety net? With an adequate health insurance cover, you don’t have to worry about the rising medical costs. Furthermore, a health insurance plan comes with several benefits that helps in getting pre and post-hospitalization care as well. One such feature is OPD cover. This blog will answer the queries like what is OPD coverage, what are its benefits and who can avail of its services.

What is OPD Cover?

OPD, or Outpatient Department cover, refers to medical treatments or consultations that do not require hospitalisation. Unlike in-patient care, where admission to a hospital is necessary, OPD treatments involve visiting a clinic or a doctor's office for diagnosis, consultation, or minor procedures. This type of care covers a range of medical needs, such as treatment for fractures, essential dental treatments, diagnostics, and minor surgeries.

Although OPD treatments are typically quicker and more straightforward than hospital admissions, their costs can add up significantly. Expenses for consultations, diagnostic tests, and minor procedures may strain your budget, especially when they occur frequently or involve specialised care.

The good news is that many health insurance policies now offer OPD cover to address these expenses. With an OPD-inclusive plan, you can claim reimbursement or enjoy cashless benefits for outpatient care, reducing your out-of-pocket expenditure. This makes OPD cover particularly valuable for individuals and families who require regular medical consultations or treatments.

When selecting a health insurance plan, it’s essential to consider OPD cover as part of your policy. Look for a plan that not only meets your hospitalisation needs but also provides comprehensive coverage for outpatient expenses. This ensures financial protection for routine medical care, giving you peace of mind and encouraging proactive health management.

Who Should Opt for OPD Cover Health Insurance Plans?

Outpatient Department (OPD) coverage is an essential aspect of health insurance that many overlook. It covers expenses for doctor consultations, diagnostic tests, and minor procedures that do not require hospitalization. But who should consider opting for OPD coverage? Let’s break it down.

Who Should Opt for OPD Coverage?

Outpatient Department (OPD) coverage is an essential aspect of health insurance that many overlook. It covers expenses for doctor consultations, diagnostic tests, and minor procedures that do not require hospitalization. But who should consider opting for OPD coverage? Let’s break it down.

Who Should Opt for OPD Coverage?

• Frequent Doctor Visitors: If you find yourself regularly consulting doctors for minor illnesses, diagnostic tests, or follow-ups, an OPD plan is indispensable. It ensures you can manage these costs without dipping into your savings.
• Young Individuals: Young professionals often choose health insurance for benefits like:

          Lower premiums

          Faster completion of waiting periods

          Tax savings

Adding OPD coverage is especially beneficial for this group, as it ensures they can avail of outpatient services even if they feel less likely to use other hospitalisation benefits.

• Employees with Group Insurance Plans: Many employer-provided group medical insurance policies exclude OPD benefits. If you already have such coverage but want additional support for outpatient expenses, you can opt for a top-up healthcare plan with OPD coverage. This complements your existing plan and maximizes your tax benefits.
• Tax Savvy Policyholders: OPD plans can also contribute to annual tax savings, making them a financially wise choice for individuals looking to optimize their health insurance benefits.

Benefits of having an Outpatient Department Coverage:

In India, OPD costs can account for up to 62% of total medical costs. Having OPD coverage can help you in many ways. The benefits of having healthcare insurance with OPD coverage are:

• A health insurance policy with OPD cover enables reimbursement of the OPD expenses within 90 days of payment.
• The sum assured for health insurance with OPD benefit is based on the age of the policyholder.
• The claims under the OPD insurance plans are determined based on the sum assured.
• Individuals who have more expenses because of pharmacy bills experience respite because OPD cover includes the pharmacy bills.
• Health insurance plans that cover OPD expenses enable individuals to claim medical reimbursements multiple times over the policy term.
• Insurance with OPD cover offers more tax benefits on the premiums paid.
• Health insurance policies that cover OPD expenses help the insured person to cover pre-and post-hospitalization expenses which can at times be greater than the hospitalization expenses.  

In medical treatment, OPD is the first point of contact. It also facilitates hospital admission screening and investigations. Niva Bupa provides GoActive medical insurance plan, which includes cashless OPD coverage. It assists policyholders in saving their hard-earned money that would otherwise be spent on routine hospital visits. The benefits of OPD coverage are included in the base premium.

It offers ten reimbursable/cashless OPD consultations within network hospitals. It covers consultations with specialists, general practitioners, paediatricians, dentists, and orthopaedics, as well as any other doctor the policyholder requires.

As we all know, healthcare costs are sky-rocketing these days. Thus, having health insurance with OPD cover will make sure that a simple visit to the doctor does not cost you your finances. So, what are you waiting for? Buy a suitable health insurance plan or group health insurance that provides coverage for your OPD requirements and other medical needs.

FAQs

1. How to claim OPD with Niva Bupa?

Claiming OPD (Outpatient Department) expenses under Niva Bupa Health Insurance is simple. 

• First, ensure your policy includes OPD coverage. Collect all necessary documents, such as bills, prescriptions, and diagnostic reports. 
• Log in to the Niva Bupa customer portal or app, fill out the claim form, and upload the documents. 
• If you prefer offline submission, visit the nearest branch or contact their customer care for guidance. 
• After submission, Niva Bupa will verify the documents and process the reimbursement. OPD claims typically cover doctor consultations, pharmacy bills, and diagnostic tests, so ensure these are well-documented.

2. What is OPD cover in health insurance?

OPD cover in health insurance reimburses expenses incurred for outpatient treatments that do not require hospitalisation. Niva Bupa offers OPD coverage as part of select plans, allowing policyholders to claim costs related to doctor consultations, prescribed medications, and diagnostic tests. This feature is especially beneficial for managing regular health expenses. OPD coverage promotes preventive care, enabling policyholders to seek timely medical attention without worrying about additional costs.

3. What is cashless OPD?

Cashless OPD allows policyholders to access outpatient treatments without paying upfront. Niva Bupa’s network of partnered healthcare providers facilitates this service. You only need to present your health card or policy details at the clinic or diagnostic center. The bills are directly settled by Niva Bupa, making the process hassle-free. This feature is especially convenient for frequent doctor visits or routine health check-ups.

4. Is OPD treatment covered in health insurance?

Yes, OPD treatment is covered under certain Niva Bupa health insurance plans. Unlike hospitalisation benefits, OPD cover reimburses expenses for treatments like doctor consultations, diagnostic tests, and pharmacy bills. It enhances financial support for routine medical needs. Check your policy details to confirm if OPD coverage is included and understand the claim limits or sub-limits applicable.