By Anand Roy
Lately, based on the changing consumer expectations, health insurance policies are getting designed which include OPD (Out Patient) cover. Investing in a health insurance policy at a young age ensures that one will have greater coverage. Many latest health plans offer wide coverage for young customers that include daycare procedures and treatment for vector-borne diseases to maternity benefits and cover for OPD expenses among others.
OPD treatment refers to the one in which an individual visits a clinic or a hospital or an associated facility for diagnosis and treatment based on the advice of a medical practitioner and does not have to be admitted as daycare or in-patient. Health insurance plans that offer OPD cover assists the insured to claim expenses other than that incurred during hospitalisation.
Who should take OPD cover?
OPD cover is for anybody who might incur healthcare costs which does not require in-patient hospitalisation. This covers minor medications like viral fever and in cases of some chronic conditions like diabetes, arthritis, or back pain. For any other chronic condition that requires regular visits to the doctor, OPD insurance is a suggested cover.
OPD cover allows one to make claims for expenses incurred, not including hospitalisation. The cost of medicines, along with diagnostics or minor procedures, is also covered under this policy. One can also claim tax exemption on the premium paid. However, it should be noted that the OPD treatments is considered only in network clinics and hospitals. One can claim OPD expenses without an extensive wait. It is usually within 90 days of availing the policy if one is claiming for a pre-existing disease or even from day one if it is not related to any pre-existing condition. One can make multiple claims within the same year until the limit is done in.
Inclusions
The OPD benefits come in several shapes and sizes. It includes fees for medically necessary consultation and examination by medical practitioners to assess one’s health for any illness. It also covers the medically necessary out-patient diagnostic procedures such as x-rays, brain and body scans, and pathology and so on used to make a diagnosis for treatment from a diagnostic centre along with prescribed medicines. In addition to this, minor surgical procedure such as POP, suturing, dressings for accidents and animal bite-related OPD procedures carried out by a doctor are also covered.
Note that OPD covers might not include all daycare procedures. So, it is always wise to check with the health insurer on what procedures one can claim this benefit for. Also, this cover typically excludes expenses incurred towards spectacles, contact lenses, cosmetic procedures, physiotherapy, and ambulatory devices like walkers, BP monitors, glucometers, thermometers, dietician fees, vitamins and supplements.
Often health insurers offer the OPD cover as an add-on with the base policy. Usually, since an OPD expense is much more likely to be utilised by the insured, this coverage comes at a higher cost. One must analyse whether the efficacy justifies the cost, keeping their health requirements and age in mind. This might look insignificant and expensive but can actually save the day when one is in a difficult situation.
The writer is MD, Star Health and Allied Insurance Co Ltd