by
icicilombard 002
| Feb 21, 2024
Health insurance is vital to our financial safety net, providing peace of mind and protection against unexpected medical expenses. Traditional health insurance primarily focuses on covering hospitalisation and in-patient treatments, leaving outpatient expenses like doctor's visits, diagnostic tests, and medications out of its scope. However, the rising costs of medical consultations and diagnostic procedures have made these expenses a substantial burden on individuals and families. This is where health insurance with OPD coverage steps in. Let’s begin with understanding the OPD coverage meaning.
OPD coverage, also known as Outpatient Department coverage, is a type of health insurance that covers the costs of medical treatments and services received on an outpatient basis.
What are some OPD benefits?
A medical insurance with OPD coverage can bring you many advantages, such as:
- Convenience: Visiting an OPD is like seeing a doctor without having to stay in the hospital. You can receive medical help and return home the same day.
- Cost-effective: OPD visits are usually cheaper than staying in a hospital. You don't have to pay for a hospital room and other expenses.
- Shorter wait times:OPDs often have shorter waiting times than emergency rooms. You can get treated faster for non-urgent health issues.
- Specialised care:OPDs have various specialists for different health problems. You can see a doctor who specialises in your specific issue.
- Flexibility: You can choose the time for your OPD appointment, making it easier to fit into your daily routine.
- Preventive care:Many OPDs offer preventive health check-ups. These can help you catch health problems early.
What is OPD treatment?
In simple terms, OPD treatment refers to medical care provided to patients who do not require extended hospitalisation. It is a type of healthcare where you visit a hospital, clinic or healthcare facility for diagnosis, treatment or consultation with a doctor, and then you return home on the same day. OPD treatment is common for many medical conditions, from routine check-ups and consultations with specialists to minor illnesses and injuries.
Common examples of OPD treatments include consultations for common colds, flu, and skin conditions, dental check-ups, vaccinations, and management of chronic diseases like diabetes or asthma.
Key benefits of OPD cover in health insurance
Here are the main benefits of having OPD cover in your health insurance:
- Covers doctor consultation fees: You can claim the cost of visiting a doctor without needing hospital admission.
- Includes diagnostic tests: Expenses for blood tests, X-rays, scans, and other diagnostic tests are covered.
- Covers pharmacy bills: You can get reimbursed for medicines prescribed during OPD consultations.
- Handles minor procedures: Small medical procedures, such as stitches or dressings, performed at clinics are included.
- Useful for frequent treatments: Ideal if you need regular visits to doctors or specialists for ongoing conditions.
What is covered in ICICI Lombard health insurance with OPD cover?
Some common inclusions in ICICI Lombard health insurance with OPD cover are:
- Outpatient expenses:OPD in health insurance covers costs for doctor consultations, diagnostic tests, and medications you need without officially being admitted to the hospital.
- Medicine and prescription costs:This includes the cost of medicines prescribed by the doctor during your OPD visit.
- Preventive health check-ups: ICICI Lombard Health Insurance includes coverage for preventive health check-ups, helping you monitor your health regularly.
- Wellbeing programme:You can access a digital platform that rewards and promotes your physical and mental wellbeing with the help of a personalised health coach service on the IL Take Care app.
- Physiotherapy sessions:You can get coverage for assessment, diagnosis and treatment of your bone and joint conditions from the network of physiotherapists.
What is not covered in ICICI Lombard health insurance with OPD cover?
ICICI Lombard OPD cover may not apply to the following:
- Any treatments or surgeries done solely for cosmetic purposes are not covered.
- It is usually not covered if a treatment is experimental or not widely accepted in the medical community.
- Injuries resulting from extreme sports or risky activities may not be covered.
- Medical expenses resulting from illegal activities are typically not covered.
- Injuries or illnesses intentionally caused by the policyholder may not be covered.
- Generally, expenses related to normal pregnancy and childbirth may not be covered under OPD coverage. You have to buy separate maternity insurance add-ons.
How do you file a claim for ICICI Lombard health insurance with OPD cover?
To file a claim for ICICI Lombard Health Insurance with OPD cover, you need to follow the steps given below:
- Visit any network or non-network hospital or clinic and avail of the OPD service.
- Pay the bills and collect the original receipts and reports from the hospital or clinic.
- Download the claim form from ICICI Lombard’s official website or mobile app and fill it out with the required details.
- Submit the claim form along with the original bills, receipts, reports, prescriptions, and other documents within the stipulated time frame for availing of the service.
- The claim will be processed and settled as soon as the claim department verifies your details.
Eligibility and limitations of OPD cover
Here are some limitations of OPD cover:
- Available with specific health insurance plans: Not all policies include OPD cover. You must choose a plan that offers this benefit, often as an add-on.
- Covers doctor consultations and minor treatments: You can use it for routine doctor visits, diagnostic tests, and medicines.
- Has a yearly claim limit: OPD cover usually comes with a fixed annual limit. Once you use it up, you cannot claim more for that.
- Requires proper bills and prescriptions: To make a claim, you must submit valid bills and a doctor's prescription. Without documents, your claim may be rejected.
- Often not available for cashless treatment: Many insurers don’t offer cashless OPD claims. You may need to pay first and get reimbursed later.
Who should you buy health insurance with OPD coverage?
Health insurance with OPD cover is suitable for anyone who wants comprehensive coverage for their healthcare needs. It is especially beneficial for:
- Individuals with pre-existing medical conditions who require regular medical consultations.
- Patients with diabetes, asthma, thyroid, or other chronic diseases that need regular medication and monitoring.
- Patients who are immuno compromised or have a higher risk of infections and diseases.
- People who wish to avail preventive healthcare and wellness services.
Difference between OPD and daycare procedure
Here is a table to help you understand the key differences between the two:
|
Aspect
|
OPD (Outpatient Department)
|
Daycare Procedure
|
|
Hospital admission
|
Not required
|
Required, but for less than 24 hours
|
|
Type of treatment
|
Routine check-ups, doctor consultations, basic tests
|
Minor surgeries or treatments like cataract, dialysis
|
|
Claim eligibility
|
Usually not covered under basic health insurance unless OPD cover is included
|
Covered under most health insurance policies
|
|
Examples
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Fever consultation, X-rays, blood tests, dental cleaning
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Cataract surgery, chemotherapy, tonsil removal
|
|
Duration
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Short visit (a few minutes to an hour)
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A few hours (but less than 24 hours)
|
|
Documentation needed
|
Bills, prescriptions, and test reports
|
Hospital discharge summary, treatment reports, bills
|
|
Policy requirement
|
Needs OPD benefit in your policy to be claimable
|
Covered under standard health plans with daycare coverage
|
Conclusion
Health insurance with OPD cover offers great value by helping you manage everyday medical expenses, such as doctor visits, diagnostic tests, and prescribed medications, without the need for hospital admission. It ensures you get more out of your policy and reduces out-of-pocket spending on routine healthcare.
If you're planning to buy a health insurance policy for family or upgrade your current one, consider one that includes OPD benefits. It provides wider coverage and helps you stay financially prepared for both major and minor medical needs.
If you need any help with choosing the right insurance plan, fill out the form on this page to get expert advice tailored to your needs. We will help you with the options and pick the best plan for your health and budget.
FAQs about Health Insurance with OPD Cover
Q.1. Can I avail of tax deductions on health insurance plans with OPD coverage?
You can avail of tax deductions on health insurance plans with OPD cover under Section 80D of the Income Tax Act. You can claim up to Rs. 25,000 as a deduction for yourself, your spouse, and dependent children, and up to Rs. 50,000 for senior citizen parents.
Q.2. Can I buy an insurance plan that covers only OPD treatment?
You need to check with your preferred insurer to see if it is a part of the regular plan or if you need to purchase it as a separate rider.
Q.3. How do I buy health insurance with OPD coverage?
You can purchase this cover by visiting the ICICI Lombard website and navigating to the health insurance section. There, you will need to provide some of your basic and health-related information and pay the premium.
Q.4. Is OPD cover included in all health insurance policies?
OPD cover is not available in all plans. You need to check if your policy includes it or choose one that offers OPD benefits.
Q.5. What documents are required to claim OPD expenses?
You usually need to submit the doctor’s prescription, medical bills, test reports and payment receipts for an OPD claim.