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What is OPD Cover in Health Insurance?

The term "OPD cover" refers to a type of health insurance that covers the cost of outpatient care. It guarantees that the health insurance company will pay the insured's out-of-pocket medical expenses.

  • 3,168 Views | Updated on: Dec 28, 2023

As hospital stays incur far larger medical bills, outpatient care can still add up to a substantial annual price if you’re not careful. Most of India’s healthcare budget goes into payments to hospitals’ Outpatient Departments (OPDs). As medical treatment expenses continue to rise, selecting a medical insurance plan that includes outpatient care is prudent. This article provides valuable information on the advantages of OPD cover in health insurance.

What is OPD Cover?

While hospitalisation may be necessary for some medical concerns, it is not necessary for everyone. For instance, if you’ve hurt yourself or have a mild sickness, you might need to go to the outpatient department. In such cases, you could go to the hospital’s outpatient clinic or emergency room to see a doctor, acquire a diagnosis via laboratory testing, and treat your condition using over-the-counter medications purchased from the pharmacy. Fees for doctor visits, diagnostic testing, and prescription medications all fall under this category.

This spending is not typically covered by standard medical insurance policies, leaving you with hefty bills. Fortunately, modern insurance providers have created plans that pay for outpatient care. In addition, the OPD cover aids the insured in claiming costs that would not be paid if they were hospitalised.

Benefits of OPD Insurance Plans

Mentioned below are some of the ways how policyholders benefit from health insurance policies that provide coverage for use in the outpatient setting.

1.Patients who need to see doctors frequently in the outpatient department, even for routine issues like viral fever, can benefit from insurance with OPD cover.

2. Large pharmaceutical expenditures incurred by the insured are covered.

3. Patients who need to see a doctor frequently due to a pre-existing ailment can benefit from having OPD cover.

4.OPD health cover can be helpful for those who are immuno-compromised as well.

5. Insurance with OPD cover is helpful for people who need to see a doctor frequently to treat chronic ailments, including asthma, diabetes, arthritis, thyroid, etc.

6.Section 80D under the Income Tax Act of India entitles OPD insurers to tax exemptions under the current tax code.

Who is benefitted from OPD cover in health insurance?

Compared to hospitalization costs, outpatient care accounts for a significant section of the nation’s overall medical expenditures. However, you should consider OPD Health Insurance in addition to your medical coverage if you are.

1. Between the ages of 20 and 45

If you enroll in health insurance at a younger age, your policy rates will be lower. Therefore, even if you believe you are young, you should still consider an OPD cover in your health insurance, as you can profit from it in some way or another.

2. You are a Fitness Enthusiast

Although you are a fitness enthusiast and less prone to become ill, you might still sustain workout-related injuries; hence, OPD health insurance can provide you with financial security in such circumstances. Additionally, medical insurance will aid you in your annual tax planning.

3. You are a Senior Citizen

If you are a senior citizen, consider purchasing OPD insurance plans in addition to your health insurance plan since you may need to visit your doctor frequently for treatments such as minor operations, routine checkups, dental procedures, etc. Therefore, in such cases, your OPD health insurance will cover all of your OPD services and consultations.

Why should you choose insurance with OPD cover?

Many people find themselves financially vulnerable due to out-of-pocket costs associated with OPD visits. Many individuals in the country may struggle to afford such therapies due to their high expenses. Therefore, it is preferable to get OPD cover in health insurance, which will work as an umbrella to protect you from all those hefty charges for tests, doctor’s consultations, treatments, pharmacy expenses, and so on. Covering outpatient care costs for yourself and your loved ones is a breeze with comprehensive OPD health insurance.


Consider getting OPD cover in a health insurance package that offers more comprehensive coverage, as there aren’t many stand-alone OPD health insurance policies available. In addition, the cost of preventative care and emergency care, as well as any minor treatments that may be necessary, will be mitigated by having such insurance in place. Remember the above information to get the most out of your OPD cover and medical insurance.

Key Takeaways

    Some of the key points about OPD insurance plans are as follows.

  • OPD Cover takes care of patients with pre-existing diseases.
  • The OPD insurance plan offers you cost-effective policies.
  • Chronic ailments are covered under OPD Plans.
  • You can take advantage of doctor consultations under your budget.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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