The Benefits of OPD Expense Coverage: Protecting Your Health and Finances

A basic health insurance plan will provide you coverage against hospitalisation and daycare procedures. However, you may need to visit a doctor in a hospital OPD for minor illnesses. These small amounts may add to a considerable amount in the long run. A health insurance plan with OPD coverage can help you cover the regular OPD expenses. In this article, we will understand the benefits of an OPD cover.

What is an OPD cover?

You may visit a doctor in an Out Patient Department (OPD) of a hospital for three major reasons:

• Treatment for minor illnesses, such as respiratory illnesses, body aches, accidental injuries, infections, etc.
• Treatment for major illnesses, such as diabetes, high cholesterol, high blood pressure, etc. that can be managed through OPD without hospitalisation.
• Regular follow-ups after recovery from a major illness, such as surgery involving the heart, brain, or any other body part.

A health cover that includes these OPD expenses is known as an OPD cover.

An OPD cover is provided in the following ways:

a) Part of the base policy

b) Optional in the form of an add-on or rider

Scope of an OPD coverage

An OPD cover may include the following expenses:

a) Doctor fees,

b) Diagnostic tests recommended by the doctor, and

c) Medicines

OPD cover may be provided on a cashless basis or reimbursement basis. When an insurance company settles the bill directly with the hospital, it is known as cashless health insurance.

Benefits of OPD expense coverage

Some of the benefits of OPD expense coverage include:

1) Saving on medical expenses

The first and foremost benefit of OPD coverage is the saving on medical expenses like doctor fees, diagnostic tests, and medicines. Without OPD coverage, you would have to pay these expenses from your pocket.

If you have an illness such as type 2 diabetes or high blood pressure, you must consult a doctor regularly. Regular blood tests to monitor the treatment progress and medicine expenses can add up to a decent amount every month, and over 6-12 months, it can become a significant amount.

But, with an OPD cover, your insurance company can cover this amount, leading to savings.

2) Diagnosis of diseases at an early stage

When you visit an OPD, specific diagnostic tests may be recommended based on your symptoms and the doctor's assessment. The test results can help in the diagnosis of disease (if any) at an early stage. Early treatment may involve fewer complications, avoidance of surgery, and less expensive. Thus, OPD coverage helps maintain or regain good health.

3) Cashless treatment

Like the cashless mediclaim policy, these days, some health insurance companies  provide OPD coverage on a cashless basis. Most insured people prefer cashless OPD coverage as it is convenient and eliminates the need to send the physical copy of bills to the insurance company and follow up for reimbursement.

4) Tax saving

Without OPD coverage, when you consult a doctor and pay from your pocket, you don’t get any tax deduction on the medical expense. However, the premium paid for OPD coverage (as part of the health insurance policy) qualifies for deduction from taxable income under Section 80D of the Income Tax Act.

OPD cover with ManipalCigna

ManipalCigna provides OPD coverage with the ManipalCigna Health 360 OPD Rider. Some of the policies with which it can be attached includes:

a) ManipalCigna ProHealth Insurance

b) ManipalCigna ProHealth Select

c) ManipalCigna ProHealth Prime Advantage

d) ManipalCigna LifeTime Health Insurance

e) ManipalCigna Lifestyle Protection – Critical Care

f) ManipalCigna Lifestyle Protection – Accident Care

With the ManipalCigna Health 360 OPD Rider, you can choose from one of the three packages based on your needs:

1) Package 1

You can choose a sum insured between Rs. 5,000 to Rs. 20,000, in multiples of Rs. 5,000. The package covers doctor consultations, including dental and vision consultations. The service can be availed through a network Medical Practitioner.

2) Package 2

You can choose a sum insured between Rs. 10,000 to Rs. 30,000, in multiples of Rs. 5,000. The other option is to choose a sum insured between Rs. 30,000 to Rs. 1,00,000, in multiples of Rs. 10,000. The package covers doctor consultations (including dental and vision consultations) and prescribed diagnostics tests. The service can be availed through a network Medical Practitioner.

3) Package 3

You can choose a sum insured between Rs. 20,000 to Rs. 30,000, in multiples of Rs. 5,000. The other option is to choose a sum insured between Rs. 30,000 to Rs. 1,00,000, in multiples of Rs. 10,000. The package covers doctor consultations (including dental and vision consultations), prescribed diagnostics tests, and prescribed medicines. Expenses incurred on medicines are covered for up to 20% of the OPD sum insured. The service can be availed through a network Medical Practitioner.

The OPD coverage is provided on a cashless basis. Any unutilised amount under the OPD benefit cannot be carried forward to the subsequent policy year.

If you are not sure which base health insurance policy and OPD package combination to purchase, you can talk to experts at ManipalCigna. They will analyse your health insurance needs and recommend the most appropriate base health insurance policy and the OPD package combination.

Purchase comprehensive health protection

When buying health protection, you should not limit yourself to purchasing a base health insurance plan. You must add OPD coverage, critical illness cover, and personal accident cover. You may include these as add-ons or riders, wherever available. If they are not available as add-ons or riders, you may purchase standalone policies. Each of these covers serves a specific purpose which a base health insurance policy may not serve. Having all these covers will provide you with comprehensive health protection for you and your family. A comprehensive health coverage will provide you with the much-needed peace of mind.