Many people assume that health insurance policies can only be used for dealing with severe medical illnesses. When it seems like they have a small ailment, they refuse to visit the doctor. They only go to the hospital when the illness has morphed into something much worse. Thus, a lot of people only claim insurance coverage when they have been hospitalised, or worse.
There is no need to delay treatment though. Visiting the Outpatient Department for even minor illnesses is very helpful for any policyholder. Not only are they having their illness dealt with, but the doctors can have an examination of the policyholder as well. They can find out if there are any hidden or latent illnesses within the policyholder as well. This provides the policyholder with an early diagnosis of any serious illness and early treatment.
Unfortunately, OPD appointments and check-ups are not free, and the cost of a consultation varies between hospitals. This makes people feel discouraged from seeking medical aid at the right time. Fortunately, some of the best medical insurance in India offer OPD coverage as part of the base plan. This is to incentivise and ensure policyholders get the medical help they want whenever they need it.
What is Included in OPD Coverage?
OPD Cover provides coverage for the following:
- Pharmaceutical Expenses
- Doctor Visits
- Outpatient Department Treatment
- Diagnostic Tests
What Isn’t Included?
These illnesses and costs aren’t covered by OPD Coverage:
- Spectacles, Prosthetic Devices, Implants, Hearing Aids, Braces, and other such aids.
- Rehabilitation and Rejuvenation costs.
- Outpatient consultations that are made outside of India.
- Dental treatment and surgery.
- Infertility, sterility, and other conditions.
- Vaccinations and Inoculation.
Eligibility Criteria for OPD Coverage
As with the eligibility requirements for any insurance policy, policyholders have to meet some simple eligibility criteria for OPD Coverage. The following are the requirements to be eligible for OPD Coverage:
- People between the ages of 25-40.
- Senior Citizens who need minor surgeries.
Benefits of OPD Coverage
OPD Coverage can save you a lot of money on medical costs. Costs like doctor’s consultations, diagnostic tests and prescription medicines will be reimbursed by availing OPD Coverage. You can thus avoid having to pay for these costs. Some other benefits of OPD Coverage are:
- Healthcare Access: Policyholders can seek medical advice and treatment for minor illnesses without worrying about how much it costs. This drastically increases the policyholder’s access to healthcare and ensures they receive the help they need.
- Early Detection: Regularly consulting the doctor for check-ups can help detect serious illnesses early and prevent them from becoming life-threatening. OPD Coverage thus not only covers health check-ups but also drastically reduces the time and cost of treating any serious illnesses by diagnosing them early.
- All-around Coverage: With OPD Coverage, policyholders receive a large spectrum of medical costs. This includes health check-ups, specialist consultations, and prescribed medicines.
- Tailored Plans: Health insurance plans with OPD Coverage can be tailored to the policyholder’s needs. This allows them to choose a policy that is customised to their needs and costs.
- Tax Benefits: OPD Coverage will be included in your health insurance policy’s tax advantages under Section 80D of the Income Tax Act.
How to Compare OPD Coverages
Getting a diagnosis, having a consultation, or being treated for an illness at the Outpatient Department requires policyholders to spend a maximum of 24 hours there. Many insurance policies cover any costs you may incur as a result of these treatments. They can also be covered through add-on covers if they aren’t covered by your base policy.
It is important to compare the various OPD coverage and policies on the following factors. This will help policyholders make an informed decision on picking the best OPD coverage for you.
- Coverage: Inspect what is covered under the policy. The coverage and exclusions offered by various insurance providers vary between them. Look at what your policy states regarding consultation fees, medical bills, diagnostic tests, and more.
- Network Hospitals: Take a look at what hospitals, clinics, and diagnosis centers are partnered with your insurance provider. These Network Hospitals offer cashless treatment, where your insurance doesn’t just cover your medical expenses. The insurance provider directly pays the hospital the full amount of your fees. Also, find out whether these Network Hospitals are near your home or office so you can have your OPD visits there.
- Claim Process: Find out what the Claim Process for your OPD Coverage is. Recognize the paperwork you must send to your insurance company to get paid back. Check whether your insurance provider offers a cashless claims process. Policyholders find cashless claims to be far simpler to handle than reimbursement-based claims.
- Premiums: Check and compare medical insurance premiums between insurance providers. Understand how OPD Coverage affects your premiums, and how it affects them. For example, OPD coverage in medical insurance for senior citizens is different from a policy for younger people. If OPD is not covered by your insurer, find out how much additional riders for OPD would cost.
Conclusion
Understanding what OPD Coverage is, understanding how it can be claimed, and looking at its benefits is important for anyone to know. This information will help you find and choose the right OPD policy for you. Some of the best medical insurance in India like Niva Bupa offer insurance policies that automatically cover OPD expenses.