Health Insurance with OPD cover

Health Insurance with OPD cover in India

Ever visited a hospital for a couple of stitches or an injection? If you have, you would have gone to the Out Patient Department (OPD). Haven’t you wondered sometimes what exactly is OPD? You may even have asked yourself – “does my health insurance with opd cover these expenses?” If you have, you’ve come to the right place.  

Through this blog, we hope to cover all those questions and more. We will also tell you why OPD expenses are not covered in most health insurance plans.  

What is an Out-patient Department? 

Simply put, the outpatient department in the hospital service takes care of patients without admitting them. If you go to the hospital for a few hours and don’t have to take a room, you are considered an out-patient. The OPD is the first point of contact for many patients. On consulting a doctor, you may then be asked to get admitted. If this period of admission exceeds 24 hours, you become an in-patient.  

The outpatient department provides three core services: diagnostics, treatment, and follow-up care. That means most of your hospital visits – from doctor consultations to blood tests are all part of the OPD. You can also visit the OPD for vaccinations, radiology tests, and treatments like bone setting and stitches.  

How Does the Out-patient Department Work? 

Almost all hospitals in India have a common flow for how the OPD department works. Here’s a handy flowchart to help you understand it.  

Do Health Insurance with OPD cover such expenses? 

Most health insurance plans do not include outpatient department visits. They, however, can be added as an additional benefit if you are willing to pay more. There is a simple reason for this- when you visit occasionally, the expenses you incur at the OPD are not as huge as getting admitted to the hospital. You don’t pay room rent and, in most cases, you don’t pay for a lot of tests. You only pay a consultation fee. 

However, if you visit the OPD multiple times in a year, then the costs tend to add up. That’s why insurance companies offer OPD as an add-on, with a higher sum insured. This also means a significant increase in your premium amount.  

The reason for this high cost is that, unlike hospitalization, there are more issues with verifying claims related to OPD expenses. Also, since OPD visits are more frequent, it is easier to hit your claim limit. Another reason is the inflated cost of medical care, which has only kept on increasing. So, the more you visit the hospital, the more expensive your bill is. To cover that cost, the insurance company has no choice but to charge you extra.  

However, many insurance companies are now looking at adding OPD to their offerings. It will help make healthcare more affordable, especially if you visit the out-patient department regularly. However, affordability is still a long way away.  

For now, we recommend you to chose a health plan without OPD coverage because it is more affordable. Generally, insurance companies charge higher for OPD coverages. It will ensure you have a stable affordable premium that covers most medical emergencies. Isn’t that better than a constantly-changing premium that adapts to rising healthcare costs? 

Does Group Health Insurance under the Onsurity plan Cover OPD Expenses? 

Like standard health insurance plans in the market, the insurance plan under the Onsurity HealthSure Membership does not cover outpatient department expenses. Our Good Doctor Team is always available to provide personalized assistance during hospitalization. So, in case you find yourself in a hospital and want to quicken the process of admissions, payment, etc. just drop in an email to gooddoctors@onsurity.com

You can use the Onsurity app to browse our online healthcare services, medical store and health check-ups provided by our partners, 1mg and Medlife. Your healthcare plan with Onsurity gives you access to discounts on medication, tests, and check-ups (subject to features of the plan). You can also use the app to book a teleconsultation with a doctor near you.  

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