Here is Everything You Need to Know about OPD Coverage in India
Health insurance is a tool that helps in financial planning. Thanks to high medical inflation, gone are the days when medical insurance in India was considered as a luxury. However, now, it is considered as a basic necessity of everyone. If you don’t have adequate health insurance coverage, you are exposed to huge hospitalization-related as well as financial risks. In case one of your dependents is hospitalized, it would be very difficult for you to arrange money at such a short notice. Medical emergencies can imbalance your financial planning in no time. During such times, health insurance comes to your rescue. Having health insurance isn’t enough, though; you ought to have sufficient health coverage no matter what.
There are different kinds of insurance plans available in the insurance market, offered by various insurance companies. Before you buy a health insurance plan in India, analyze your current and potential insurance needs, as it helps you decide which health insurance plan will suit you the best. Typically, a health insurance plan covers hospitalization expenses for the insured. There are some insurance providers that offer outpatient department coverage too. In this article, we will tell you everything that you need to know about OPD Coverage in India.
What is an OPD health insurance cover?
In India, 62 percent of out-of-pocket healthcare expenses contribute to the overall healthcare expenditure of an individual, today. That being said, there is a wide scope of plans offering OPD cover. Health insurance policies offering OPD cover help policyholders claim expenses other than the hospitalization charges.
OPD cover is an add-on cover offered by a few health insurance companies in India. It can be opted for after paying an additional premium.
What are the benefits of the OPD cover?
Mentioned below are the benefits of the OPD coverage:
1. Minor Expenses Coverage- It covers minor non-hospitalization related expenses, such as routine health check-up, X-ray, doctor’s consultation charges, blood tests charges and daycare charges.
2. Pharmacy Expenses- It is ideal for individuals or families who incur pharmacy-related expenses on a regular basis.
3. Tax Benefits- While OPD coverage attracts extra premium, it is eligible for claiming the tax deduction as per Section 80D of the Income Tax Act, 1961. As compared to basic medical insurance in India, OPD plans offer more tax benefits.
Note- No Tax Deductible at Source (TDS) is levied on the claims.
4. Value for Money- The extra premium that an insured has to pay to avail OPD coverage offers value for money. The amount that one pays for OPD premium is lower than the incurred OPD expenses.
Typically, health insurance plans offering OPD cover offer the benefit of claim reimbursement on treatment expenses multiple times as long as the policy is active. While outpatient health treatments offer a wide range of health care services, an insured can file claim multiple times. It enhances the value for money.
5. Attractive Discounts- Upon renewal, a few health insurance providers offer discount on the OPD premium, in case no OPD claim has been filed in the previous policy period.
6. Age-Based Assured Sum- For basic health insurance plans, sum assured and claims are computed on the basis of the needs for hospitalization for a minimum of 24 hours. On the other hand, for health insurance plans offering OPD cover, the insurance premium is calculated on the basis of the insured’s age.
7. Shorter Waiting Period- OPD health insurance plans come with a shorter waiting period of up to 90 days of buying health insurance.
The Need of Buying OPD Cover
If you need to consult a doctor and purchase medicines on a regular basis, then OPD cover is a must for you. It offers health coverage to the patients of diabetes asthma, etc. If an insurance policy offers enhanced coverage, it should take care of various OPD treatments as well.
For instance, you have a basic family floater health insurance plan with a sum assured of Rs. 5 Lakhs. You pay health insurance premium of Rs. 15,000 per annum. In order to include OPD cover for Rs. 15,000, you paid an additional premium of Rs 17,000. However, the limitation of claiming the OPD benefit would be Rs 15,000 considering tax benefits.
What is there for you to gain?
The OPD cover is formulated to fulfill various insurance expectations of the insurance buyers. Some cover OPD charges under the option of reserved benefit. It can be easily used to pay for various bills, such as pharmacy, dental treatment, consultations, diagnostic tests, and so on.
Difference between Day Care Treatments and OPD Treatments
People tend to believe that daycare treatments and OPD treatments are the same and blatantly use it interchangeably. The thin line of difference between the two is elaborated below:
OPD Treatments
Under outpatient department treatment, the diagnosis and treatment of the illness are done as advised by the doctor. Additionally, it can also be done by visiting a health clinic or a consultation center. In order to file a claim, OPD treatments don’t come with a pre-requisite of hospitalization. All you have to do is walk into a clinic/hospital and undergo the medical treatment after getting hospitalized.
Day Care Treatments
In order to file a medical insurance claim, the insured must be admitted to a hospital for a period of at least 24 hours. That being said, there are a few treatments that don’t require a long duration due to technological developments and advancements. While undergoing a daycare procedure, you need to be admitted even if it is for a short period of time. Otherwise, you won’t be able to file a claim.
Regardless of the similarities between the Outpatient department and day care treatments, the stark difference is the level of hospitalization.
In a Nutshell
Undoubtedly, OPD coverage offers a much-needed benefit. It can be availed by paying an additional premium. Before opting for the OPD coverage, analyze if the utility value is in coordination with the premium by keeping your health insurance needs as well as your age in mind. Insurance experts recommend calculating your family’s potential usage of basic healthcare and compare cost vs. benefit.
Also, pay attention to the sub-limits and restrictions (if any) on offered healthcare the services