Ajay Sharma, a Delhi resident, was diagnosed with a liver ailment six months ago which eventually led to three-day hospitalisation costing ₹1.2 lakh in total. A large chunk of it was covered by his medical insurance policy. There were, however, a number of follow-up visits to doctors and diagnostic centres which cumulatively cost him more than his hospital bill. He is now contemplating upgrading his policy to incorporate the outpatient department (OPD) cost as well.
And he is not alone. It is often seen that the hospital expenses are only a part (although significant) of the overall medical cost.
Usually, OPD treatments are frequent in nature and include the treatment for basic viral fever, infection, regular health check-ups or follows up for ongoing medication. This results in a huge amount of bill for an insurance company and consequently, mostly insurers keep them out of the policy’s ambit.
“If an insurance plan includes an old age person, kids, or a person ailing prolonged disease who require frequent visits to the doctor for regular check-ups and consultations then OPD coverage, undoubtedly, is an integral part. Else, OPD is not suggested to be a part of the base plan as a young healthy person doesn’t need frequent visits to a doctor. Also, the OPD comes with sub-limits and OPD requires a limited cost involvement which a policyholder can easily afford,” says Naval Goel, CEO and Founder, PolicyX.com
Some of the OPD Health insurance plans offered by insurers
| Insurer | Policy |
| Aditya Birla Health Insurance | Activ Health Enhanced Platinum Plan |
| Bajaj Allianz | Tax Gain Health Insurance Plan with OPD Cover |
| Digit Health Insurance | Digit Health Insurance with OPD cover |
| Niva Bupa | GoActive Health insurance plan |
| Star Health Insurance | Outpatient Care Insurance Policy |
Why to take OPD cover?
Experts opine that the inclusion of OPD cover is vital in the medical insurance plan if you factor in the rising medical costs and the growing reliance on online consultations. Mr Naval Goel, CEO of PolicyX says it is significant for policy holders to take OPD cover particularly when regular consultations are indispensable because of a pre-existing disease.
“With the effect of COVID-19, hospital visits have become riskier due to the heavy risk of infection. Thus e-consultations have become essential for the masses to consult with doctors to reduce the exposure of the COVID19. It depends on the policyholder whether they need regular consultations and follows up on account of pre-existing diseases. In such case, having OPD and e-consultations provide good options to policy holders,” says Mr Goel.
Abhishek Misra, chief executive officer and principal officer, Bonanza Insurance echoes the same sentiments. “I think policy holders should go for it (OPD cover) even if they won’t use it. That is how things work in case of medical insurance. It is meant for healthy people. Already unhealthy ones don’t get the medical insurance any way,” Misra remarks.
The premium charged by insurers for OPD coverage is usually not exorbitant, but it is important to know that the number of OPD visits is also restricted for policyholders.
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“Earlier medical insurance policies only used to offer hospitalization but increasingly most policies offer OPD cover also. Some of them charge an extra ₹1,500 to ₹2,000 and provide a certain number of consultations, say, 10,” says Misra.
So, we can say that OPD cover is imperative for those policy holders who want to minimise the possibility of unanticipated medical expenses burning a hole in their pockets, particularly the ones who have a pre-existing disease leading to frequent visits to a doctor.