Health insurance tips: Why you should get OPD treatments covered



In the case of a serious illness or hospitalisation, the cost is covered by your health insurance. However, a number of follow-up visits to doctors and diagnostic centres before and after the hospitalisation often sums up to be an equally bigger chunk. When not covered by health insurance, the burden of these expenses can burn a hole in one’s pocket.

While health insurance plans are readily available at the click of a mouse, the detailed information of the same that benefits the policyholders is often not to hand. Many insurance companies prefer to keep OPD treatments out of the plans, as of which most of the policyholders are unable to enjoy the benefits of it. The OPD cover is for everyone who feels they might incur healthcare expenses without having a serious, prolonged illness that requires hospitalisation.

Here, we will briefly explain why insurance companies try to avoid adding OPD plans and why policyholders must add the same in their health plans.

What is OPD treatment?

Outpatient department, or simply, OPD treatment is wherein certain treatment or diagnosis of a certain type of illness upon the advice of a medical practitioner. This involves the patient visiting the clinic or any of the doctors’ consultation rooms.

Why insurance companies avoid covering OPD?

OPD treatments are frequent in nature and include the treatment for basic viral fever, infection, regular health check-ups or follow-up for ongoing medication. Hence, many insurance companies keep OPD treatments out of the policy’s ambit as it results in a huge cost for them.

“If an insurance plan includes an old-age person, kids, or a person ailing prolonged disease who require frequent visits to the doctor for regular check-ups and consultations then OPD coverage, undoubtedly, is an integral part. Else, OPD is not suggested to be a part of the base plan as a young healthy person doesn’t need frequent visits to a doctor. Also, the OPD comes with sub-limits and OPD requires a limited cost involvement which a policyholder can easily afford,” says Naval Goel, CEO and Founder, told Livemint.

Why you must include OPD in insurance cover?

Experts say that due to the rising medical costs and the growing reliance on online consultations, the inclusion of OPD cover is highly important “It is significant for policyholders to take OPD cover particularly when regular consultations are indispensable because of a pre-existing disease,” Naval Goel, CEO of PolicyX, said.

“With the effect of Covid-19, hospital visits have become riskier due to the heavy risk of infection. Thus e-consultations have become essential for the masses to consult with doctors to reduce the exposure of the COVID19. It depends on the policyholder whether they need regular consultations and follow-up on account of pre-existing diseases. In such a case, having OPD and e-consultations provide good options to policyholders,” Goel added.

Abhishek Misra, CEO and principal officer of Bonanza Insurance, said policyholders should go for it (OPD cover) even if they won’t use it. “That is how things work in the case of medical insurance. It is meant for healthy people.,” Misra told Livemint.

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