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Popular health insurance policies that cover OPD and doctor consultation

There are many health insurance policies in India that now offer OPD coverage as an in-built feature or can be bought as an add-on.

Notwithstanding the growth in health premiums, insurers have seen elevated levels of Covid claims in the first three months of the financial year due to the second wave of the pandemic.

Notwithstanding the growth in health premiums, insurers have seen elevated levels of Covid claims in the first three months of the financial year due to the second wave of the pandemic.

Sunainaa Chadha New Delhi

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COVID-19  highlighted the necessity of introducing comprehensive health insurance policies in India that advance the healthcare safety net. One such policy is the OPD add-on cover, which helps policyholders cover medical costs that do not require hospitalization and do not drain their savings.

There are many health insurance policies in India that now offer OPD coverage as an in-built feature or can be bought as an add-on. 

"OPD coverage allows policyholders to make claims for expenses related to medical diagnosis or treatment received outside of a hospital or daycare facility, as recommended by a medical professional. These claims can cover costs incurred during visits to clinics, hospitals, or similar locations, without requiring the patient to be admitted as an in-patient or daycare participant," said Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com.

Additionally, policyholders can make claims for expenses beyond those incurred during hospitalisation with the help of OPD coverage. 

Singhal believes this is a must-have add-on in today’s time that covers you extensively. 

The policy coverage varies among plans, so always check the details before choosing. 

Some options for OPD coverage include Manipal Cigna Prime Advantage, Niva Bupa Smart Health Plus OPD rider, and Aditya Birla Activ Health Platinum Enhanced Plan. The range of sum insured for OPD coverage in these plans could be Rs 5,000-50,000, shows data analysed by Policybazaar.

 ICICI Lombard offers an OPD insurance plan that covers expenses related to doctor consultations, diagnostic tests, and pharmacy bills. They also have a dental insurance plan that covers expenses for dental treatments such as fillings, root canal treatment, and extractions.

 Some plans also give the option to upgrade the coverage per policy and also provide worldwide coverage. 

Polizybazaar has curated a list of the most ideal policies for a 35 year old. 

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Common expenses that are covered under OPD health covers:

Doctor consultations: A regular health insurance plan may not cover consultation fees for occasional visits to seek medical advice. However, by opting for an OPD add-on, you can ensure that this expense is covered by your policy. This add-on is especially useful in family plans that include coverage for children, as doctor visits are likely to be frequent.

Diagnostic tests: An OPD add-on covers the cost of diagnostic tests, even if you are not diagnosed with an ailment, as long as they are prescribed by your doctor.

Pharmacy expenses: Prescribed medicines expenses are not covered under regular health insurance plans, but with an OPD cover, these expenses are also covered by the policy.

Dental procedures and other aids: Routine health plans do not provide coverage for dental procedures such as tooth extraction, fillings, and root canal treatment. However, by choosing the OPD add-on cover, individuals can obtain financial protection against expenses incurred for such procedures, including the cost of dentures up to a set limit.

Moreover, the coverage extends to hearing aids and eyewear such as spectacles and contact lenses, with a predetermined maximum limit.

The OPD limit is generally defined in the policy wordings and is usually a part of the sum insured. Any claims or reimbursements filed under OPD are deducted from the overall sum insured.

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First Published: Aug 23 2023 | 8:40 AM IST

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