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OPD Cover In Health Insurance

A simple visit to a doctor to get medical consultation and prescription falls into the category of the OPD or outpatient department. The medical expenses are not too much for the OPD, but when these ordinary medical expenses are calculated for the whole year, the OPD treatment looks very expensive. The most important thing is that OPD treatments do not require hospitalisation. 

There are health insurance plans that may not offer coverage if the hospitalisation lasts for less than 24 hours. However, many insurance companies include certain OPD treatments in the coverage. These may include general treatments like treatment of fractures, dental treatment, and minor surgeries. Hence, the policyholders are choosing health insurance with OPD cover to get relief from the high medical expenses of the OPD. 

What is OPD cover?

OPD cover health insurance is the plan that is chosen by the policyholders to claim the medical expenses related to the doctor consultation, diagnosis lab test reports, and medical prescriptions. These medical expenses are not covered by the regular health insurance plans given by the insurance companies for the hospitalisation. Hence, the insurance companies are providing monetary help to the policyholders by settling their OPD treatment claims. 

Health insurance plans with OPD cover in 2022:

Check out the list of the best health insurance plans with OPD cover in 2022 here:

Best health insurance plans with OPD coverHighlighting Features of the Plan
ICICI Lombard Complete Health InsuranceExtensive OPD coverage
Cashless treatment in over 6700 healthcare centres 
Manipal Signa Lifetime HealthCovers global OPD
Sum insured of up to INR 3 crores
Max Bupa HeartbeatUnder the Platinum cover get your outpatients treatments covered
Varios day care treatments covered 
Bajaj Allianz Tax Gain Plan Extensive coverage for hospitalisation as well as OPD
Ambulance cover, pre and post-hospitalisation, daycare covered
Care Health Insurance PlanSum insured up to INR 1 crore
Over 19000 healthcare centres in the network
SBI Arogya Plus PlanCovers OPD expenses
Similar premiums across age groups
Aditya Birla Activ Health Enhanced PlanCovers day care treatments
Covers dental consultation and diagnosis

Benefits of choosing the OPD cover in health insurance plans:

If you are planning to buy health insurance plans, and thinking about whether you should buy OPD cover in health insurance plans or not, then, you should read the following key benefits:

  • Going to the doctor doesn’t become a costly affair, especially for everyday problems such as fever etc.
  • The policyholders who buy the OPD insurance plans don’t have to worry about the medical expenses on the doctor consultation, diagnosis lab test reports, and medical prescriptions. They enjoy the health care services and lead a healthy life
  • Under Section 80D. Tax benefits are enjoyed by the policyholders
  • It is beneficial for those patients who are suffering from chronic illness and require multiple visits to the doctor.

Why is OPD cover necessary?

Are you thinking about whether or not you should buy OPD cover medical insurance? Then, it is recommended that you buy it as it will give you great assistance by settling your claims of the doctors’ diagnosis, treatments, and medications. There are many health insurance providers which provide exclusive benefits to the policyholders by managing their heavy expenses on daycare treatments. They are not admitted to hospitals to get daycare treatments. However, the doctor’s fee, diagnosis reports, and medications can burn a big hole in your pocket. If you want to keep yourself away from all these financial troubles, then buy a good OPD cover health insurance for you and your family today. 

Eligibility Criteria:

Please look at the following eligibility criteria to avail of the OPD benefits:

  1. If you want to buy health insurance with OPD for your child, your child should be of 90 days at least. He/ she should not be more than 18 years to get the child health insurance policy
  2. If you want to buy a health insurance plan with OPD coverage for yourself/ spouse/ parents/ siblings, then, the age group of 18 -65 years will be followed
  3. If your age is more than 70 years, then, the exclusive plan will be offered by the health insurance providers. 

Who should buy OPD cover health insurance?

The following persons could buy OPD cover health insurance:

  • If your age is between 20 to 45 years, then you can buy health insurance with OPD because you will be able to buy this plan at cheaper premiums
  • If you are an aged person, then, you are associated with the risk factors of chronic illness. To get stress-free medical treatment, it will be wise for you to buy the OPD cover
  • If you are prone to work-out or sports-related injuries, then you should buy OPD medical insurance to get financial and medical help in times of OPD treatment. 

What is covered under OPD treatment in health insurance?

OPD treatment in health insurance includes the following health cover benefits:

  • Medical consultation
  • Lab reports
  • Medical prescriptions.

What is not covered under OPD treatment in health insurance?

OPD treatment in health insurance excludes the following treatments:

  • Cosmetic treatments
  • Expenses on spectacles, contact lenses, hearing aids, dental braces, etc.
  • Pleasure-seeking massages and treatments
  • OPD treatments outside India. 
  • Regular health check-ups
  • Experimental treatments
  • Gynaecologist treatment for infertility 
  • Miscarriage
  • Dental treatment.

How to settle the claim for OPD treatment?

You can settle the claim for OPD treatment in the following ways:

  • Reimbursement claim
    After getting the treatment related to OPD, gather all the medical documents, i.e. doctor consultation, medical prescription, and lab test reports. Submit these documents to the official website of the insurance company to settle the claim.
  • Cashless claim
    Visit the network hospital of the insurance company and show your health card. By showing your health e-card, you can ask for cashless OPD treatment in the hospital. The insurer will settle the bills directly and you will only have to pay for the uncovered expenses. 

How to buy a health insurance plan with OPD coverage?

If you have decided to buy a health insurance plan with OPD coverage, you should do it via one of the best online platforms to buy it. Visit Turtlemint and get the best quotes as per your requirement. Follow the following steps to complete the process of buying the health insurance plan with OPD cover in no time:

  • Step 1: Firstly, visit the website of Turtlemint
  • Step 2: Select the option of ‘Health’ on the top menu bar
  • Step 3: A pop-up menu will appear with several options. Choose the option ‘Buy, compare or renew health insurance’ 
  • Step 4: Scroll down the screen and find the option ‘Buy Health Insurance Plans’
  • Step 5 : Then, you will be redirected to a new page to complete the health profile
  • Step 6: Fill in all the personal details accurately to get the appropriate health insurance plans according to your needs
  • Step 7: Compare the health insurance plans by clicking on viewing details
  • Step 8: Choose the best one for you. Then, fill in the required details, including contact details, insured details, medical history, and mailing address. Upload all the mandatory documents
  • Step 9: Buy the insurance plan after making a payment. 


Buy the best health insurance plan with OPD cover according to your requirement. In this way, you will be able to manage the financial burden due to OPD treatments. Not only this, but you will also get the health benefits when you get the best treatment to cure your health without thinking about the doctor’s consultation fee and medications. Lead a happy and stress-free life by getting OPD medical insurance coverage. 


This article is issued in the general public interest and is for educational purposes only. The blogs should not be used as a substitute for competent expert advice from a licensed professional to best suit your needs. Insurance is a subject matter of solicitation. For more details on policy terms, conditions, exclusions, limitations, please refer/read policy brochure before concluding sale.


Under section 80D of the Income Tax Department, you can avail of the tax benefits by buying the OPD cover health insurance. The premiums that you pay towards your policy will be tax exempted.

Regular health insurance plans give financial assistance to the policyholders for their hospitalisation. But OPD cover includes OPD treatments. These OPD treatments are basic health treatments that do not require any kind of surgery or hospitalisation.

No, the settling of the OPD treatment-related claim is not really a long process. Cashless claims are easier as the insurance company settles the bills directly with the hospital. Reimbursement on the other hand may require some time for your bills to be validated, but if your paperwork is complete, that also will be settled in a few days.

Day care treatment includes hospitalisation but not more than 24 hours. In most cases, you can not get the benefits of OPD medical insurance for day-care treatment, however, it is recommended that you check your particular health plan for the same.

Health Insurance Companies