Opting for an outpatient department (OPD) rider can help reduce out-of-pocket expenses such as doctor’s fees, diagnostic costs and pharmacy. While a standard health insurance covers inpatient expenses, adding a rider is a flexible and cost-effective way to enhance the coverage for individuals with chronic conditions who require frequent medical attention.
In metros, the average cost of OPD services can range anywhere between Rs 1,500 to Rs 2,000 per doctor consultation and diagnostic tests may cost Rs 8,000-10,000. An OPD coverage will offer financial protection for medical expenses that do not necessitate hospitalisation.
An OPD rider is a cost-effective option as the premium starts from as low as Rs 700 per year. Siddharth Singhal, business head, Health Insurance, Policybazaar.com, says on an average, adding OPD coverage would increase the total health insurance premium by just 8-10%. “These plans offer OPD coverage ranging from Rs 5,000 to `Rs 30,000. With their easy availability, countless benefits and affordability, their demand is steadily increasing,” he says.
Scope of coverage OPD riders typically cover consultations, diagnostics, coverage of prescribed medications from the pharmacy bills, dental treatment, etc. Some health insurance plans might have a waiting period or exclude pre-existing diseases conditions. So, if you have any pre-existing medical conditions, check whether they are covered and understand the waiting periods or exclusions that may apply. It is advisable to prefer cashless OPD coverage for seamless transactions over the reimbursement-based plans.
Bhaskar Nerurkar, head, Health Administration Team, Bajaj Allianz General Insurance, says an individual must ensure that the outpatient coverage is not restricted to a specific network of hospitals. “If it is, ensure it meets your needs. If you have any pre-existing medical conditions, check whether they are covered and understand the waiting periods or exclusions that may apply,” says Nerukar.
Most health insurance plans with an OPD coverage do not cover cosmetic and aesthetic procedures such as plastic surgery, weight loss treatments or even non-allopathic treatments, etc. Additionally, health supplements and over-the-counter drugs which are not prescribed by the doctor are excluded under the OPD coverage.
While a few insurers offer built-in OPD plans, experts say it is better to opt for a rider. Rakesh Goyal, director, Probus, an insurance broking company, says built-in OPD plans might help in easy integration but the premium is higher as compared with an OPD rider. “An OPD rider would be cost-effective and allow customisation to the insured based on his outpatient needs,” he says.
An individual must decide on the sum insured based on his annual outpatient expenses. Some outpatient benefits may require a co-payment, which means that the policyholder will have to pay a certain percentage of the claim amount. “Consider the co-payment percentage and how it will affect your out-of-pocket expenses,” says Nerurkar.
At the time of renewal, if a policyholder does not find the OPD rider beneficial, he may discontinue it. Some OPD plans also include coverage for preventive health check-ups which can help identify potential health issues early and reduce the risk of severe conditions in the future.
An individual must carefully review the policy documents and understand the terms and conditions when selecting an outpatient cover to ensure it aligns with his healthcare needs and financial situation. It is advisable to
compare the policy premiums online to find the best deal for such plans.