How OPD Cover in Health Insurance Can Help You Save on Medical Expenses

Shift Risk
April 7, 2023

OPD Cover benefits in health Insurance India 

 According to a report by Statista, 22% of Indians consult with a physician at least three times a year, and that's where OPD coverage comes in.  Without OPD cover, you would have to bear the cost of these consultations, even with a health policy. In this article, we will explain what OPD cover is and how it can benefit you.

What is OPD Cover in Health Insurance?

OPD or Out-Patient Department refers to the diagnosis and treatment of ailments that do not require hospitalization. This includes medical conditions like dental check-ups, eye tests, and minor illnesses like fever and cough. With OPD cover in your health insurance plan, you can visit a clinic, consult with a doctor, and receive medication by paying a consultation fee with a short appointment.

Benefits of Health Insurance with OPD Cover

Having OPD cover in your health insurance plan has several benefits, especially since many health issues are minor and don't require hospitalization. Below are some advantages of OPD cover.

Coverage of OPD Expenses: You can claim expenses incurred during outpatient treatment, including diagnostic fees, consultation fees, medicine bills

Access to Wide Range of Clinics and Hospitals: With OPD cover, you have access to a wide range of clinics and hospitals across India.

Multiple Claims within the Same Policy Year: You can file multiple claims within the same policy year, up to the capped limit set by your insurer.

Coverage for Pharmacy Bills: Depending on your insurance provider, you can claim pharmacy bills and the cost of medicines under health insurance with OPD cover.

No Requirement for Hospitalization: Unlike other health plans that require 24 hours of hospitalization for claiming expenses, there are no such requirements under OPD cover.

Here is a list of medical expenses included under the OPD cover benefit:

  • Diagnostic fees
  • Minor surgical procedures
  • Medicine bills
  • Dental procedures and treatment (depending on the insurer)
  • Consultation fees
  • Cost of hearing aids, crutches, lenses, dentures, eyewear, etc.
  • Ambulance cover
  • Additional covers may also be available for extra coverage depending on your insurer.

Who Should Opt for Health Insurance OPD Cover?

While OPD cover is suitable for most individuals, here are some people who should consider purchasing this cover:

Individuals Between the Age of 25 to 45 years: While major surgeries or injuries are rare at this age, frequent illnesses like colds and dental care are common. OPD cover can help you save on minor expenses that you incur several times a year and offer worry-free finances.

Individuals Who Are Older Than 45 years: With old age comes illnesses and an increased likelihood of sustaining injuries due to brittle bones. Regular visits to the doctor for minor conditions can easily take a toll on your savings. Health insurance with OPD cover can offer extensive coverage for all types of medical treatment, ensuring that your retirement fund is not utilized for healthcare expenses.


OPD cover is a vital component of any comprehensive health insurance plan. It covers all outpatient expenses, including diagnostic tests, doctor consultations, and pharmacy bills. By purchasing health insurance with OPD cover, you can enjoy a wide range of benefits and access to a network of clinics and hospitals. It's important to choose a policy that suits your healthcare needs and offers maximum coverage.

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Written By:
ShiftRisk Team