image title

OPD Expense Coverage In Health Insurance Policy

Joan Mathews Joan Mathews 23 May 2019

Many insurance companies are beginning to include OPD cover as a feature to the health insurance policies offered by them. This article highlights the many benefits of an OPD cover and how it can be used to protect one’s finances in uncertain times.

image title

In the past, health insurance policies would mostly only cover hospitalization charges. But with time, a number of insurers have expanded the scope of their health insurance products to provide financial coverage to a wider range of health requirements. Today, one can find health policies that cover OPD expenses, like consultation fee, diagnostic tests, pre-emptive check-ups, etc. This move has mainly been prompted by the rise in lifestyle-related health issues, causing an increasing number of people to head to the doctor, for even small medical interventions.

Health Insurance Policies with OPD Cover

Some of the policies that include OPD cover are:

  • Bajaj Allianz Tax Gain Plan - This is a family floater policy that covers outpatient (OPD) expenses and hospitalization expenses. An individual can make a claim for dental procedures & treatment, crutches, dentures and cost of spectacles, among others, under the OPD section.

  • Apollo Munich Maxima - This is a health insurance plan that offers unique out-patient benefits to take care of regular illnesses. An individual can make a claim for doctor’s consultation fee, pharmacy expenses, diagnostics, specialist services and health check-up benefit under the OPD Section.

  • Max Bupa Heartbeat - This is a health insurance plan that provides a comprehensive medical coverage for individual as well as extended family. An individual can make a claim for charges incurred toward OPD treatment and/or diagnostic services and/or prescribed medicines for the OPD treatment, as per terms and conditions.

  • ICICI Lombard Health Protect Plus, Health Smart and Health Smart Plus - The three health insurance plans by ICICI Lombard come with OPD cover. The insured will be reimbursed the medical expenses incurred as an outpatient, following submission of all the original bills of medicines/consultations to the insurance company.

Is OPD Cover Necessary?

Those who require doctor’s consultation on a regular basis and have to purchase medicines frequently, like diabetics, asthmatics, etc., are advised to avail Mediclaim policies with OPD cover. While the costs incurred on OPD may not seem as significant when compared with hospitalization expenses, they can accumulate overtime and end up costing the individual a sizeable amount. To prevent such instances from arising, it is advisable to avail an OPD cover. With more financial security in place, the individual is better able to paddle his or her way out through uncertainties.

An essential point to be noted is that health insurance policies with OPD coverage will cost more than those which do not have this feature. Therefore, it is essential to analyse whether the utility value justifies the cost, keeping the health requirements and age of insured members in mind. Factor in the likely usage of primary health care and conduct a cost-benefit analysis, prior to availing Mediclaim policies with OPD cover.

Now, besides the benefit, it provides in securing one’s finances as the extra premium paid for taking the OPD cover would be eligible for tax deduction under Section 80D of the Income Tax Act, 1961, under the prescribed limit. Those individuals who want to exhaust the tax breaks available can consider going for policies with OPD cover since the premiums paid for policies with this feature is higher when compared with regular Mediclaim covers.


Healthcare treatment is not simply restricted to hospitalization, it includes check-ups, diagnostics, post-surgery consultations, etc. OPD expenses may not seem like a big amount, but considering the rising medical inflation, it helps to have adequate financial security in place.

Today, a single doctor visit can cost anywhere around Rs 1,000- Rs 2,000. Having an OPD cover can bring relief to one’s pocket as the individual would be able to claim consultation fees, pharmacy and health check-up bills, up to the policy’s pre-described limit. However, as mentioned above, it is important to compare the cost with the benefits.

Policies with OPD cover is definitely recommended to those suffering from ailments, which require them to visit the doctor often, as well as to senior citizens, who are vulnerable to various illnesses. For such individuals, a little extra spent on premiums can go a long way in providing complete financial protection against all health hazards.

Joan Mathews
Written by Joan Mathews
Joan has over 4 years of experience writing for the BFSI industry. She enjoys watching mystery TV series, listening to 80s classics and spending time with her furbabies.