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Nobody wants to get sick, but when they do need medical help, they can rely on their health insurance plan to cover the expenses. But, most of these insurance policies only cover surgeries, hospitalization, and other major medical expenses.
However, you can purchase add-on covers to customize your insurance policies with coverage tailored to your medical needs. One such additional coverage is OPD (Outpatient Department) coverage.
OPD coverage covers your medical costs, and patients do not need to be hospitalized. So how is it beneficial for you? Do you really need health insurance with OPD coverage? Read on to find out.
OPD coverage is usually offered as an add-on cover for an existing health insurance policy. This add-on cover pays for the cost of treatments available in the hospital's Outpatient Department.
The Outpatient Department takes care of minor medical emergencies which do not require patients to be admitted for more than 24 hours or as daycare treatment for a minimum of 24 hours.
All your routine doctor visits, consultations, prescription drugs, and diagnostics are conducted in the OPD. And OPD coverage pays for all these OPD-related expenses for you. It also covers all your consultations, be it from dentists, general physicians, paediatricians, or therapists.
Health insurance plans generally offer OPD coverage in two ways:
OPD rider is available as an add-on for your existing health insurance coverage for which you pay an extra premium. To claim the OPD rider, you must submit bills for outpatient treatments received and the insurance provider will reimburse you up to the specified limit.
You can also add OPD coverage to your health insurance as a cash benefit by paying an extra premium. However, cash benefit gives you only a fixed amount of money when specific medical events occur, regardless of your expenses.
Here are some benefits of a health insurance policy with OPD coverage:
Medical expenses can snowball for patients who frequently visit doctors for consultations, therapy sessions, medications and tests. However, with OPD coverage, these routine medical expenses are taken care of for you by your insurance provider.
Most health insurance policies cover only surgeries and hospital stays, though we all know that healthcare is much more than that. OPD coverage covers other crucial medical expenses like consultations, therapy sessions, medications, etc. A health insurance policy with OPD coverage is one of the most holistic health covers you can get, covering even minor issues like viral fever.
We all have heard that prevention is better than cure. You must go through regular health check-ups, screenings, and vaccinations if you want to avoid developing serious health issues. With OPD coverage, you can take care of these preventive care expenses as well.
A health insurance plan with OPD coverage also comes with some tax benefits. The premiums you pay for OPD coverage are eligible for tax deductions under Section 80D of the Income Tax Act, 1961.
Here are some drawbacks of OPD coverage you must consider:
OPD cover provides coverage for medical expenses that are usually excluded from standard health insurance policies. As a result, they are more expensive and require you to pay a higher premium.
Although OPD coverage is quite extensive, it can still exclude certain medical expenses. For instance, you cannot raise claims for cosmetic surgeries, pre-existing conditions, and alternative or unproven treatments.
At a time when medical bills are skyrocketing and the risk of serious illnesses is also increasing among adults, a health insurance plan is an absolute necessity. One must ensure they get OPD coverage along with insurance to cover your recurring medical bills.
However, OPD coverage does not cover cosmetic and alternative treatments. So, if you prefer treatments other than Allopathy, like Homeopathy or Ayurveda, you must ensure your insurance provider covers them.
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Policies, Codes & Other Documents