Updated on - 30 Jan 2026
Health expenses don’t just come from emergencies; frequent doctor visits, routine tests and medicines can quietly add up and strain your budget. Traditional health insurance mostly helps during hospitalisation, leaving everyday healthcare costs uncovered. That’s where health insurance with OPD cover becomes essential. It ensures you get timely consultations, treatments and medicines without worrying about out-of-pocket costs.
In this blog, we’ll break down OPD benefits, what’s covered, exclusions, the claim process and who can gain the most from having OPD coverage.
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.
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 does OPD claim process work?
Filing an OPD claim is generally simpler than a hospitalisation claim. After visiting a clinic or doctor for consultation, tests or therapy, pay the bill and collect all original documents, including receipts, prescriptions and test reports.
Next, fill out the OPD claim form provided by your insurer and submit it along with the documents through the insurer’s app, website or other approved channels within the stipulated time. Once verified, the insurer will reimburse the eligible amount.
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.
Who should you buy health insurance with OPD coverage?
Health insurance policy with OPD coverage is ideal for anyone seeking comprehensive support for routine healthcare needs. It is particularly beneficial for individuals with pre-existing conditions who require regular consultations, patients managing chronic diseases like diabetes, asthma or thyroid issues, and those who are immunocompromised or at higher risk of infections.
It also suits people who want access to preventive healthcare, regular check-ups and wellness services to stay on top of their health.
Factors to consider before buying OPD health insurance
Before buying OPD health insurance, carefully consider several key factors. Check the details of coverage to ensure doctor visits, tests, pharmacy bills, physiotherapy and routine preventive check-ups are included.
Review the annual OPD limit to confirm it meets your expected usage, especially for family plans. Be aware of any waiting periods before benefits become active. Evaluate the claim process for ease, particularly through mobile apps.
Compare the premium cost with expected benefits, and ensure the network of clinics and labs is strong for easy access and potential cashless facilities.
Difference between regular health insurance and OPD health insurance
Here is how a regular mediclaim policy differs from a health insurance policy with OPD cover:
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Feature
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Regular health insurance
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OPD health insurance / OPD add-on
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Hospitalisation cover
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Covers in-patient costs upon admission, including room rent, surgery, ICU, etc.
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Typically does not cover long hospital stays; focused on outpatient visits
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OPD services
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Not covered (or very limited)
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Covered: doctor consultations, tests, medicines, physiotherapy, etc.
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Cost
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Premium depends on sum insured and risk
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Premium increases when OPD add-on is selected
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Claim mode
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Mostly cashless in network hospitals
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Mostly reimbursement; cashless for some OPDs via specific apps or riders
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Use case
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For major illnesses and hospital emergencies
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For regular health maintenance, chronic disease management and prevention
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Tax benefits of health insurance with OPD cover
Premiums paid for health insurance, including OPD add-ons, are eligible for tax deductions under Section 80D of the Income Tax Act. You can claim deductions for policies covering yourself, your spouse, children and even your parents. The maximum deduction depends on the age of the insured members.
These tax benefits help lower your overall financial burden while maintaining comprehensive health coverage, making it easier to manage routine medical expenses along with major healthcare needs.
Conclusion
Health insurance with OPD cover ensures you are prepared not just for major medical emergencies but also for everyday healthcare needs, reducing stress and out-of-pocket expenses. It empowers families, seniors and people with chronic conditions to access timely consultations, tests and treatments without financial strain. Choosing the right individual health insurance plan means you can focus on your health rather than costs.
For personalised guidance on the best plan for your needs, fill out the form on this page and get expert advice tailored to your lifestyle and budget.
FAQs
1. How does OPD cover help with chronic disease management?
OPD coverage allows regular monitoring, doctor visits and prescription refills for chronic conditions like diabetes, asthma or thyroid disorders, helping prevent complications and hospitalisations.
2. Can OPD claims be cashless?
Some insurers, including ICICI Lombard, offer cashless OPD claims at network clinics and hospitals. This means you may not have to pay upfront, making routine care more convenient.
3. Are preventive health services included under OPD cover?
Yes, many plans cover preventive check-ups, vaccinations and wellness services, enabling early detection of health issues and promoting long-term well-being.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.
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