purchase an OPD cover

Is it necessary to purchase an OPD cover with your health insurance policy

In recent years, the demand for comprehensive health insurance policies has increased as people have become more aware of the potential financial implications linked with medical emergencies. One aspect that is often debated when considering a health insurance policy is the inclusion of an Outpatient Department (OPD) cover.

When it comes to opting for a health insurance policy, individuals often debate whether it is necessary to include an OPD (Outpatient Department) cover. An OPD cover provides coverage for medical expenses incurred on outpatient treatments, consultations, and diagnostic tests.

What is an OPD cover?

An OPD cover is a feature that reimburses outpatient expenses such as consultations, diagnostics tests, and medications. In other words, it provides coverage for medical treatments that do not require hospitalization. While most basic health insurance policies strictly cover hospitalization expenses, they may fall short when it comes to meeting everyday medical costs.

Reasons for choosing OPD Cover in Health Insurance

Now, let’s explore some reasons why including OPD cover in your health insurance plan can be beneficial:

  1. Rising cost of healthcare: The cost of healthcare has witnessed a significant increase over the years due to medical inflation. While inpatient treatments can burn a hole in your pocket, so can frequent visits to doctors and diagnostic tests. Having an OPD cover as part of your health insurance plan helps alleviate this financial pressure.
  2. Covers pre-existing conditions: Most regular policies only begin to cover pre-existing conditions after a specified waiting period – which can be anywhere between two and four years. However, with an OPD cover included, policyholders can get immediate financial assistance for treatments related to such conditions.
  3. Encourages preventive care: Including an OPD cover in your health insurance encourages proactive and preventive healthcare activities like regular checkups, vaccinations, and early diagnostics screenings, which can help detect potential issues before they escalate into more severe conditions.
  4. Offers coverage for alternative treatments: With growing interest in alternative medicine such as Ayurveda, Homeopathy, or Naturopathy among others, some insurers have designed their OPD covers to include such treatments. This way, you can get financial assistance for a wider range of healthcare options.
  5. Tax benefits: Similar to the premium you pay for your health insurance policy, the premium paid towards an OPD cover is also eligible for tax deductions under Section 80D of the Income Tax Act.

However, there may be certain limitations depending on specific policy terms and conditions.

With all these benefits in mind, it is essential to recognize that not every individual or family may find it necessary to purchase an OPD cover along with their health insurance policy. Depending on your unique circumstances and needs, it is important to consider the pros and cons.

Factors to help you make an informed decision

Outpatient Department (OPD) insurance cover has emerged as a popular choice for managing the expenses of medical treatments that do not require hospitalization. OPD cover can be beneficial in addressing the financial burden of routine healthcare expenses. However, before deciding to invest in an OPD cover, there are some factors you need to consider to determine if it is necessary.

1. Medical History and Lifestyle:

Assess your personal and family medical history, along with your lifestyle choices, to determine the frequency of doctor visits or specialist consultations required per year. If you have a history of chronic illnesses or are prone to health issues due to lifestyle habits, an OPD cover may be necessary for managing routine healthcare expenses.

2. Prevalence of Pre-existing Conditions:

OPD policies usually exclude pre-existing conditions or have certain waiting periods before covering these ailments. Carefully analyze the policy’s terms and conditions related to pre-existing conditions before choosing an OPD cover.

3. Range of Benefits Covered:

The scope of coverage provided by various OPD policies can differ significantly. Some policies cover only doctor consultations and diagnostic tests, while others include dental treatment, physiotherapy sessions, or alternative therapies as well. Choose a policy that offers benefits tailored to your specific needs.

4. Copayment Options:

Analyze if the chosen OPD policy has co-payment clauses that require you to pay a percentage of the claim amount from your pocket. Policies with high co-payment percentages might not offer significant savings in the long run.

5. Claim Settlement Process and Network Hospitals:

A hassle-free claim settlement process and a wide network of hospitals and clinics are crucial aspects to consider when selecting an OPD insurance plan. Ensure that the insurer has partnered with reputable healthcare providers in your vicinity for your convenience.

6. Premiums and Coverage Limits:

Consider the premium amount and coverage limits of the OPD policy. If your expected annual medical expenditure is relatively lower than the plan’s premium, you might want to reconsider this option.

7. Impact on Income Tax:

In some countries, OPD expenses are eligible for income tax deductions. This aspect needs consideration while evaluating the necessity of an OPD cover.


An OPD cover could be a valuable asset in managing regular healthcare expenses that do not require hospitalization. However, it is essential to consider various factors, such as medical history, pre-existing conditions, benefits offered, claim settlement process, and your financial situation before making a decision. Weighing these factors will help you gauge if an OPD cover will serve your needs effectively.

While the decision to include an OPD cover in your health insurance policy ultimately depends on your unique healthcare needs and financial considerations, there are undeniable benefits to having outpatient treatment coverage. An OPD cover enhances accessibility to healthcare, reduces financial burdens associated with routine medical expenses, and ensures a more comprehensive approach to healthcare coverage. By evaluating OPD cover options and considering personal health factors, individuals can make an informed decision that aligns with their healthcare needs. Remember, health insurance policy is an investment in your well-being, and an OPD cover may provide the added peace of mind and financial security you seek.