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Health Insurance with OPD Cover

OPD coverage in health insurance includes benefits like outpatient treatments, diagnostics, and preventive check-ups. ICICI Lombard offers comprehensive coverage including physiotherapy and wellbeing programs.

  • 21 Feb 2024
  • 4 min read

Health insurance is vital to our financial safety net, providing peace of mind and protection against unexpected medical expenses. While many of us are familiar with the basics of health insurance, there's a valuable coverage feature that is gaining increasing attention and importance: OPD.

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: Going to an OPD is like visiting a doctor without staying in the hospital. You can get medical help and go back 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 words, OPD treatment pertains to medical care offered to patients who do not need extended hospitalisation. It is the type of healthcare where you visit a hospital, clinic, or healthcare facility for diagnosis, treatment, or consultation with a doctor, and then you go home 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.


What is Covered in ICICI Lombard Health Insurance with OPD Cover?

Provider of one of the  , ICICI Lombard covers plenty.  Some common inclusions in this coverage 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 program: 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 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 claim department verifies your details.


Who Should You Buy Health Insurance with OPD Coverage?

Health insurance with OPD cover is suitable for anyone who wants comprehensive coverage for their health care needs. It is especially beneficial for:

  • People with pre-existing medical conditions who need frequent medical consultations.
  • Patients with diabetes, asthma, thyroid, or other chronic diseases who need regular medication and monitoring.
  • Patients who are immunocompromised or have a higher risk of infections and diseases.
  • People who wish to avail preventive health care and wellness services.


Also read:

FAQs about Health Insurance with OPD Cover


Q.1. Can I avail of tax deductions on health insurance plans with OPD coverage?

Ans. 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?

Ans. Health insurers usually cover OPD expenses in their standard plans. 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?

Ans. 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.


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