All you need to know about OPD insurance plans

The Covid-19 pandemic has resulted in an increase in medical expenses towards OPD treatment. The fact that an average Indian family spends close to Rs 4,000 to Rs10,000 per annum on outpatient treatment has led to an increase in demand for insurance plans that cover OPD expenses. For example, Reliance General Insurance Company has recently launched an OPD product called Digital Care Management policy that is designed to cover regular outpatient expenses. The product got approval under the Insurance Regulatory and Development Authority of India’s (IRDAI) regulatory sandbox guidelines, which allow insurers to do testing of innovative products in a controlled environment.

“During Covid-19 people abstained from visiting doctor clinics or hospitals due to the fear of the virus, giving way to faster adoption of digital methods for OPD treatment like tele-medicine, online pharmacy etc. Thus, it became imperative to introduce an OPD policy like Digital Care Management, that covers the new-age digitally-savvy Indian from the financial burden of such Out-of-Pocket expense irrespective of the treatment mode,” said Rakesh Jain, ED and CEO of Reliance General Insurance.

Hence, if you are considering buying an OPD plan here are a few things you should know beforehand:

1. The basic health insurance policy gets triggered if there is a hospitalisation of more than 24 hours. The regular doctor’s visit is not covered under basic mediclaim plans. OPD plans on the other hand cover the outpatient department expenses such as doctor consultation fees, medicines, among other things.
2. However, in the case of hospitalisation, the basic policy covers OPD expenses under the pre-hospitalisation period of 30-90 days and post-hospitalisation period of 60-180 days
3. OPD cover can either be bought as an inbuilt feature in the base plan, as a rider or as a separate plan.
4. OPD covers generally come with some sum insured capping or other conditions such as limitations on the number of visits.
5. The claim process is mostly done through reimbursement, which can be a bit cumbersome. The policyholder needs to fill the form with proper bills and other required documents to claim the amount. Many insurers give the opportunity to claim it online.
6. OPD covers are expensive compared to the sum insured offered under such policies. For example, for the Rs5000 OPD sum insured a year, the charges could be as high as Rs 3,500.
7. OPD plans cover a wide range of expenses such as online medical expenses, pharmacy expenses, investigation expenses, dental and ophthalmology cover, among others.
8. Both individual and family floater options are available under OPD plans
9. Consider buying an OPD policy as a second layer of protection after buying a basic health insurance policy in order to have comprehensive coverage for you and your family.