What is health insurance with OPD cover and its benefits

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Tired of incurring OPD expenses for every hospital visit? Invest now in one of these top 5 medical plans that also offer benefits on OPD expenses.

Not every visit to the hospital requires treatment or hospitalization. Some hospital visits are limited to OPD, i.e. outpatient department. This department in the hospital takes care of cases of less serious patients that do not require urgent medical attention, such as emergency situations.

However, truth be told, the expenses incurred while visiting an OPD hospital can be a huge amount and sometimes even burn a hole in the pocket of the bearer. This may be due to high number of visits to the OPD, i.e. the patient is repeatedly called for doctor consultations, diagnosis, diagnostic tests, taking X-rays or other procedures carried out in the OPD.

To reduce the financial burden of patients bearing OPD expenses, some Medical insurance The schemes offer exclusive benefit of OPD cover. Let’s take a look at at least 5 schemes that can provide financial relief to patients and their families in difficult times.

What is OPD in hospital?

Before talking about health insurance plans that include OPD benefits, let’s briefly understand what OPD is in a hospital setting.

OPD is the abbreviation of Out Patient Department. As the name implies, outpatient is the exact opposite of inpatient unit, where patients admitted to the hospital for treatment (short or long term) are seen. As opposed to this, the Out Patient Department or OPD is where patients who require medical consultation during visits to diagnose their respective health conditions come.

OPD patients consult the resident doctor or physician and pay the consultation fee. Therefore, the OPD medical unit is responsible for overseeing appropriate medical care for all patients who visit the hospital for initial diagnosis of this condition. Upon diagnosis and treatment recommendations, some patients are directed to the IP department for admission to intensive care.

read more: Difference between Day Treatment and OPD Treatment

What is OPD in Health Insurance?

Above we have learned what proper OPD means and what OPD unit of a hospital looks after. Now, what does OPD mean in the context of health insurance? Let’s understand below.

We have discussed earlier that OPD stands for Out Patient Department and its responsibility is to provide basic care and assistance to a patient when he first comes to the hospital. Now all patients visiting the OP department of a hospital have to pay a certain consultation fee or fee for consulting a particular doctor or specialist. All these charges are collected by the OP department of the hospital.

The cost of bearing these OPD expenses can sometimes be marginal depending on the number of visits required. This is where the OPD cover benefit of health insurance comes as a huge relief.

What is health insurance with OPD cover?

Above we have learned the meaning of OPD in the specific context of health insurance. Now let us briefly understand what OPD coverage means in terms of health insurance.

Some Health insurance plans Giving their policyholders the benefit of additional OPD coverage, which means that certain non-urgent, less critical health conditions can now be covered. This is especially helpful considering that most health conditions that require medical attention are non-urgent and non-threatening. In this case, a simple visit to the doctor’s clinic for consultation or diagnosis may invite a certain amount of expenditure.

This includes a doctor’s consultation fee in addition to the cost of conducting diagnostic tests, scans or X-rays (if required). These costs certainly add up and can sometimes be a huge burden for the patient and his family.

Now, imagine a medical entitlement policy that comes with the included benefit of OPD expense insurance! This will result in a substantial portion of your medical expenses being fully covered by the insurer! Of course, OPD insurance comes with various benefits, which we will discuss in the next section.

Benefits of OPD Insurance Cover

Some of the key benefits of getting this card are:

  • Coverage of routine medical bills, especially pharmacy (if you want to buy medications monthly)
  • Coverage for non-urgent medical visits to the hospital (those not requiring hospitalization), which may be minimal in a year.
  • Coverage for routine medical consultations and health check-ups at the hospital
  • Additional cover on top of hospitalization expenses
  • Tax benefits on premium
  • Flexibility to withdraw medical bills more than once to cover medical expenses as they arise

Learn more: Difference between OPD and IPD treatment

5 Best Health Insurance Plans With OPD Expenses Coverage Benefits

Above we have discussed the main benefits of buying OPD insurance cover. If you’re considering investing in one of these, here are the top 5 plans worth shelling out your money for:

Name of Insured Health insurance plan with OPD expenses coverage Minimum sum insured Plan Benefits Insurer’s claim settlement rate
Max Buba heartbeat Rs. 15 lakhs Universal coverage, no limit on room rent, maternity insurance, OPD treatment expenses reimbursed, alternative therapies like Unani, Ayurveda etc are also covered. 89.46%
Moneypal Cigna Lifelong health Rs. 3 crores Domestic and International coverage, Global coverage with no limit on room rent, hospitalization expense in India, unlimited reinstatement of cover for unrelated health conditions 91%
Aditya Birla Active Health Enhanced Program Between Rs. 2 lakh and Rs. 2 crores Health insurance, chronic care and wellness benefits are all included in one plan, along with the cost of modern treatments, such as oral chemotherapy and robotic surgery. 94%
SBI Aarogya Plus Scheme Rs. 1 lakh, 2 lakh and 3 lakh OPD cover for the entire family includes several covers like mental illness cover, HIV/AIDS cover, and genetic disorder cover. 96%
Bharti Print Health Advance Edge Rs. 2 lakh; Up to Rs. 3 crores OPD coverage for vaccinations for newborns in the first year of birth, dental treatments, air ambulance within the country, residential hospitalization and health benefits 90%

read more: Health insurance plans with OPD expenses coverage benefits


Health insurance with OPD cover is a very useful insurance product as it provides coverage for routine expenses or high drug charges incurred due to frequent visits to the OPD. To know more about the best OPD health insurance in India, check out PayBima, which provides detailed information about the top and leading insurers offering health insurance benefits in India.

Is this post informative? Browse PayBima blogs Read related interesting posts Medical insurance, Motor vehicle insurance, Bike insurance, Term life insurance And Investment section. You can visit PayBima Buy insurance online.

Frequently Asked Questions on Health Insurance with OPD Cover Benefits

Which scheme covers OPD treatment in Tata AIG?

Tata AIG Medicare Premier is designed to cover OPD dental treatments and procedures, advanced diagnostic tests and emergency air ambulance services.

Is OPD in HDFC Ergo?

HDFC Ergo OPD Cover provides cost coverage for all OPD treatment procedures and expenses incurred.

Is there a tooth in the OPD?

Some health insurance companies offer OPD cards that cover treatment of dental problems up to a certain limit specified in the plan.

What type of patients are received by OPD?

A hospital’s OPD provides assistance to patients who do not require hospitalization or who do not require a hospital bed for overnight stay. These patients visit outpatient facilities at the hospital, such as a diagnostic testing center or physician’s clinic, for primary diagnosis and treatment.

What is Cashless OPD?

Some health insurance plans also include a cashless OPD coverage benefit, which means that the cost of OPD procedures and treatments like doctor’s consultation, purchase of medicines from the pharmacy or laboratory diagnostic tests are all covered under the policy.


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Jesuraj S

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