Increasingly, more people opt for outpatient department (OPD) benefits in their health insurance plans. Health insurers extend various features in their plans to maximise medical coverage for the insured. Many may not be aware of the difference between OPD care and in-patient department treatments. You may consider overall coverage in your plan, including (but not limited to) wide network hospitals, individual/family floater plans, surgery cover, etc. Your health insurer should provide you with crucial features like OPD and IPD coverage. Let’s understand the key differences and understand ways to get the maximum benefit of these features from your healthcare plan.
OPD care refers to a medical facility located within the hospital or healthcare centre that caters to the cost of medical consultations, diagnosis, and treatment without a patient being admitted.
After evaluating the condition of the patient, the doctor/OPD nurses perform necessary diagnostic tests and consults regarding various treatments or medications without hospitalizing the patient. OPD care is typically done on an outpatient basis.
OPD Coverage in your healthcare plan
OPD care in your health insurance covers short-term visits to the medical doctor for regular checkups or a visit for an illness that does not require admission to the hospital. The following may be covered under OPD care:
Consultation Fee: Covers the fees for visits to a health practitioner or specialist for a session.
Health Check-Ups (Preventive or Regular): OPD care ensures your regular doctor visits for any disease or condition are covered under the plan. These can be your visits regarding pregnancy, physiotherapy treatments, etc. In case of persistent medical conditions like diabetes, PCOS, and infections - OPD coverage makes sure your follow-up treatments/visits are insured.
Minor Illnesses: You can get clinical care for minor illnesses, injuries, and medical methods that do not require hospitalisation beyond 24 hours.
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In-patient department care consists of a comprehensive health insurance plan. It covers costs for patients who need to be admitted to the hospital for a certain period. Major surgeries, complex medical treatments, and critical seasonal infections/diseases require inpatient care and hospitalisation.
IPD insurance cover in your plan would include:
Hospital Admission Costs: If the patient is admitted to the hospital, IPD will cover treatment expenses, room rent, and nursing costs. Diagnostic tests, surgical treatments, operation theatre (OT) costs, etc. will also be covered.
Intensive Medical Care: For patients who require intensive treatment, the IPD coverage ensures continuous treatment and monitoring for critical medical conditions. The illness/disease is assessed, and immediate care is provided for any immediate or further complications.
Follow-up Procedures: There are many pre and post-hospitalization needs during the ongoing course of treatments for any critical/seasonal illness/surgery checkups and follow-ups. IPD ensures that you can later claim expenses for any such hospitalisation.
Medication Bills: Some IPD insurance plans provide overall coverage against the cost of medicines and drugs prescribed during the hospital stay and sometimes for the following course of treatment.
If you suffer from any chronic illness/disease/condition, you should ensure that any health plan you purchase must have comprehensive OPD coverage. This can provide you with many benefits such as:
Regular Medical Cost: OPD coverage will help you not feel overburdened by frequent medical consultations, diagnostics, and medicines, which may not be covered under a basic/standard health insurance plan.
Wider Coverage: They offer a wide scope of coverage including regular health check-ups and diagnostic tests, which encourage preventive care.
Emergency Care: Imagine you need to visit a hospital due to an urgent health condition such as any injury resulting from a minor accident. The treatment you may receive under OPD care will be covered in your plan.
Cashless OPD: Coverage for dental treatment, diagnostic tests, eye care, pharmacy, doctor consultation fees, etc. will be easily reimbursed if you choose the right health insurance plan that extends cashless OPD care.
OPD cover sometimes is added as a rider to any existing health insurance policy you might have as an extended feature to provide flexibility and comprehensive coverage. However, the option depends on the insurer and policy you choose. Remember to check policy conditions and inquire with your insurance agent regarding such add-ons and treatments insured under the same.
