What are the Benefits of Buying a Health Plan with an OPD Cover?


Medically reviewed by

Bajaj Finserv Health

Aarogya Care

5 min read

Key Takeaways

  • Claim medical expenses other than hospitalization costs with an OPD cover
  • OPD cover also provides reimbursement on diagnostic and investigative tests
  • Dietician consultation fees and physiotherapy costs are excluded from OPD cover

There has been a substantial growth of 25% in the health insurance sector during the last few years [1]. While investing in a health insurance policy it is important to manage your hospitalization expenses, you need to be aware that outpatient expenses can also cost you a huge sum. Moreover, there is a drastic difference in OPD costs between private and public hospitals. As per a study, a district hospital charged Rs.94 for an OPD visit while a private hospital charged Rs.2213 [2]. The difference is huge! That is why you need to buy a health plan with OPD cover.

OPD means out-patient department where you can access services like consultations, diagnoses, and treatment without getting hospitalized. If you purchase a health plan with an OPD cover, you are reimbursed for your expenses on medical consultations with specialists. To know more about OPD cover and why it is beneficial, read on.

Additional read: Exclusions of Health Insurance Cover

Why do you Need to Buy a Health Insurance Plan with an OPD Cover?

Health plans with an OPD cover allow you to claim amounts on expenses other than hospitalization costs. When you approach a doctor for any treatment that does not require a night stay at a hospital, an OPD cover pays for the expenses you incur. 

The rising number of diseases due to changing lifestyles may require you to see a doctor often. This can increase your medical costs. So, availing a policy with OPD benefits helps you manage your daily medical needs without a strain on your pocket. 

When you invest in a plan with OPD benefits, you can claim tax exemption for the premiums you have paid. Another advantage is that you can claim reimbursements on consultations multiple times during the tenure of the policy. Since OPD includes a lot of services, the monetary value of a health plan with an OPD cover is more in comparison to a regular health plan. You are allowed to claim OPD reimbursements within 90 days after you have taken the policy.

Steps to Buy Health insurance Plan with OPD cover

What are the Benefits of Getting Covered for OPD Expenses?

Getting an extra cover provides you with extra protection. With this cover, you can claim your vaccination and general illness expenses. This is not the case when you avail a regular plan. With OPD coverage, you can also get reimbursed for your pharmacy bills. This is a big advantage for those who have monthly pharmacy expenses. 

Apart from medical bills, this cover also reimburses expenses on optics, dentures or crutches. The best part is you can claim these amounts as and when you spend. In a plan with an OPD cover, the total coverage is based on the insured member’s age. Even if you have a family floater plan, all members included in a policy can avail this benefit. 

If you are suffering from medical conditions like diabetes, arthritis or asthma, you may need regular doctor consultations. Getting an OPD cover can be beneficial during such situations. 

You can avail a policy with an OPD cover without restrictions when it comes to eligibility criteria. Since it is a part of your health plan, the eligibility of your plan is all that matters. If your plan has OPD benefits, you can utilize them. 

Who Should Invest in a Health Insurance Plan with an OPD Cover?

While a health insurance plan with an OPD cover is useful for all, it will definitely benefit you: 

  • If you are prone to illnesses due to low immunity
  • If you are a senior citizen and you need to undergo diagnostic tests, minor surgeries or routine medical checkups
  • If you fall in the age group of 25-40 years and require more out-patient treatments than hospitalization
  • If you are a fitness enthusiast and are prone to injuries related to workouts
  • If your existing health insurance coverage is very basic such as if you have a group insurance cover from your employer 

What are the Inclusions of an OPD Cover?

These are the common services included in an OPD cover:

  • Diagnostic tests
  • Pharmacy costs
  • Doctor consultations
  • Investigative tests
  • Surgical treatments that do not require hospitalization
  • Dental procedures
  • Routine checkups
  • Vaccination costs
  • Contact lenses and spectacle expenses (covered only by specific plans)
  • Minor medical procedures like dressing of wounds
  • Costs of buying equipment such as wheelchair and crutches
Additional read: How to Save Money on Doctor Consultation

Are there any Exclusions in an OPD Cover?

Before getting an OPD cover, understand its exclusions:

  • Cosmetic procedures
  • Costs incurred on buying devices such as
  • Thermometers
  • BP monitors
  • Glucometers
  • Physiotherapy
  • Dietician consultation fees
  • Expenses incurred for buying supplements and vitamins

Now that you realize the benefits of OPD coverage, invest in health insurance that covers such treatment. Be it diagnostic tests, doctor consultation or pharmacy expenses, using your OPD cover can ease your financial burden. Invest in an ideal policy only after you evaluate your requirements and compare plans. You can browse through a range of Aarogya Care health insurance plans on Bajaj Finserv Health. The Complete Healthcare Solution is one such plan that offers doctor consultation benefits up to Rs.17000. It also reimburses you for lab tests and gives you up to 10% discounts at network hospitals. So, sign it for it today and enjoy OPD coverage!

Published on 8 Feb 2022Last updated on 18 Jul 2023
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482741/
  2. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069728

Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.

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