OPD insurance cover rises four-fold in 3 years: What are its benefits

Rising health care costs make OPD cover mainstream, with more Indians using it for doctor visits, tests and medicines

Hospital outpatient department (OPD) coverage, once seen as a niche add-on, is becoming a mainstream feature in health insurance. Almost 22 per cent of health policies now come bundled with OPD benefits, up from just 5 per cent three years ago on their platform, according to Policybazaar.

 

Everyday health care

 

Traditional health insurance was largely designed around hospitalisation. OPD cover changes that by taking care of day-to-day medical needs like:

 

• Doctor consultations (35-40 per cent of usage) 
• Diagnostics (25-30 per cent) 
• Pharmacy bills (20-25 per cent) 
• OPD coverage includes dental treatment, mental health consultation, and preventive check-ups.

 

Unlike hospitalisation claims that may be used only once in several years, OPD policies see far more engagement. Customers typically make three to four claims annually, according to Policybazaar.

 

 

OPD coverage expands

 

“Over the last three years, OPD has transformed the way customers perceive health insurance. Instead of waiting for hospitalisation to use their cover, people are now engaging multiple times a year for doctor visits, medicines, or diagnostics,” said Siddharth Singhal, head of health insurance at Policybazaar.

 

The company gave three reasons for OPD coverage demand:

 

Ease of use: Around 90 per cent of OPD claims are cashless, working much like a payment wallet at clinics or pharmacies.

 

Digital adoption: Tele-consultations (45-50 per cent) are nearly on par with physical visits (50–55 per cent).

 

Broader coverage: OPD insurance plans cover dental, vision, physiotherapy, and even nutrition counselling.

 

Who is buying OPD cover

 

Urban professionals in their 30s and 40s make up the largest segment of OPD users. Tier-I cities account for half of all adoption, though Tier-II centres are catching up quickly. Mumbai, Hyderabad and Chennai stand out as hotspots of high demand.

 

While men form the majority of current users (80 per cent), women are an emerging growth segment. Seniors, too, are increasingly opting for OPD plans to manage recurring medical expenses.

 

Another appealing part of OPD cover is preventive health care. Insurers report 5-10 per cent fewer hospitalisation cases among OPD adopters, as patients are more likely to seek early intervention for health issues, according to Policybazaar.