Best Health Insurance Plans with OPD Cover in India

OPD treatment, which refers to medical treatment received in an outpatient setting, has become an integral part of the healthcare system, with more and more people opting for consultations, diagnostic tests and treatments on an outpatient basis.

However, these expenses can add up quickly, making it crucial for individuals to have health insurance plans with OPD coverage. Here are some reasons why health insurance with OPD benefits can be useful:

1. Early detection of chronic health problems such as diabetes, hypertension, heart disease, etc.
2. Access to specialist care such as consultation with a cardiologist, endocrinologist, neurologist, etc.
3. OPD treatment is generally less expensive than inpatient hospitalisation.
4. OPD treatment is often more convenient for patients.

Health insurance with OPD coverage can help manage medical expenses, but it may not cover all costs. In such cases, individuals may need to explore other financing options to cover the expenses not covered by their health insurance plan.

There are several financing options available for health insurance with OPD cover, including the ones discussed below.

1. Individual Health Insurance: Plans offering OPD coverage come with a deductible and co-pay clause that requires the policyholder to pay a portion of the expenses out of his/her pockets. 
2. Family Floater Health Insurance: This is a type of health insurance that covers the entire family under a single policy. It offers OPD coverage for all members of the family, including children and parents. 
3. Medical EMI Policy Option: In case the patient does not have health insurance coverage for OPD expenses, he/she can take a zero-cost EMI policy from the service provider, if applicable.

When purchasing a health insurance policy with OPD cover, it's important to understand the inclusions and exclusions of the plan. These factors for health insurance with OPD cover may vary depending on the specific policy and insurance provider.

However, some of the common inclusions and exclusions are as follows:

Exclusions:

1. Cosmetic or aesthetic treatment
2. OPD treatment outside India
3. Non-medical expenses
4. Experimental or unproven treatment
5. Pre-existing conditions
6. Injuries resulting from adventure sports
7. Self-inflicted injuries 
8. Injuries from drug or alcohol abuse
9. Dental treatment

Inclusions:

1. Outpatient consultation fees
2. Charges for diagnostic tests 
3. Prescribed medicines
4. Emergency treatment 
5. Physiotherapy sessions

An OPD cover is important for individuals who regularly need outpatient services. There are several health insurance plans available in India offering OPD coverage to pay for medical services that do not require hospitalisation.

Below are the 7 best health insurance in India with OPD cover: 

1. Max Bupa Health Companion Plan: This plan offers coverage for medical expenses incurred for OPD consultations, diagnostic tests, medicines and dental treatments, among other benefits. Here are some of the interesting features of this plan:
   1. Sum Insured: This health insurance plan provides policyholders with a wide range of sum insured options, ranging from INR 3 lakhs to INR 1 crore. 
   2. Eligibility: This health insurance plan has a minimum entry age of 18 years for adults and 91 days for children, with no maximum age limit for adults and a maximum age limit of 21 years for children. 
   3. Network Hospitals: Policyholders of the insurance company can simply access cashless hospitalisation options through the insurance company's extensive network of over 7,400 hospitals.
      This insurance company has a network of over 9,490 hospitals affiliated with the policy.
   4. Claim Process: The Niva Bupa Health Companion Plan, formerly Max Bupa, provides policyholders with a simple and practical claim process.
      Following the type of treatment, the plan provides both cashless and reimbursed choices.
      Policyholders can present their medical bills and documents for costs spent during hospitalisation or medical treatment in the event of reimbursement.
   5. Waiting Period: The waiting period for Max Bupa health insurance can vary depending on the specific policy and the type of medical treatment required.
      In general, most health insurance policies have a waiting period of 30 days from the date of policy inception, during which no claims can be made for any medical expenses unless it is an emergency hospitalisation.
   6. Claim Settlement Ratio: The Max Bupa Health Companion provides an impressive claim settlement ratio of 96%.
   7. Other Features: The smart top-up option provides additional coverage to policyholders if their existing coverage is exhausted.
      This means that policyholders can get extended coverage beyond their sum insured limit without any hassle.
      Moreover, the plan also offers a sum insured refill benefit of up to 100% in case of exhaustion, ensuring that policyholders are covered for any unexpected medical expenses that may arise.
2. HDFC ERGO Health Optima Restore Plan: This plan offers comprehensive coverage for hospitalisation and OPD expenses, including consultations, diagnostic tests and prescription drugs.
   Here are some of the top features of this insurance plan:
   1. Sum Insured: It offers a flexible range of sum-insured options, which makes it an attractive choice for policyholders.
      With coverage amounts ranging from INR 3 lakhs to INR 50 lakhs, individuals and families can select the sum insured that is most suitable for their unique healthcare needs and financial capabilities.
   2. Eligibility: The health insurance policy is available for individuals from 91 days old up to 65 years of age. 
   3. Network Hospitals: This offers a network of over 10,000 hospitals where policyholders can avail of cashless hospitalisation and other healthcare services.
   4. Claim Process: This offers both cashless and reimbursement claim options. To initiate a claim, the policyholder needs to inform the insurer within 24 hours of hospitalisation for planned hospitalisation or within 48 hours for emergency hospitalisation. 
   5. Waiting Period: There is an initial waiting period of 30 days for all illnesses except for accidents during the first year. However, this waiting period is not applicable in subsequent renewals. Pre-existing diseases are covered after a waiting period of 36 months.
   6. Claim Settlement Ratio: The HDFC Ergo Health Optima Restore Plan boasts a remarkable claim settlement ratio of 99.8%, standing at the forefront.
   7. Other Features: It is a comprehensive medical insurance plan that covers all day-care procedures and ambulance costs up to INR 2,000.
      It also offers complete coverage on room rent and 100% restoration of the sum insured, ensuring you never run out of coverage.
      In addition, the plan provides renewal incentives for those who do not make a claim, allowing for enhanced coverage of up to 100% without any extra cost.
3. Reliance Health Infinity Plan: This plan provides coverage for OPD expenses, including consultations, diagnostic tests and medicines, and hospitalisation expenses. Some of the features of this insurance plan are stated below: 
   1. Sum Insured: The policy offers coverage from INR 5 lakhs to 5 crores, ensuring that you can choose a coverage amount that suits your financial requirements.
   2. Eligibility: The Reliance Health Infinity Insurance Policy covers children from 91 days to 25 years of age, and adults from 18 years to 65 years of age, ensuring that all family members can enjoy comprehensive medical coverage.
   3. Network Hospitals: Over 7,300+ network hospitals are empanelled with the insurance provider, ensuring that policyholders have access to quality healthcare services at a wide range of locations.
   4. Claim Process: The Reliance Health Infinity Plan offers a hassle-free claim process.
      The insured person can inform the insurance company by calling their helpline or website and submitting the necessary documents, such as original medical bills and reports.
      Once the claim is approved, the reimbursement amount is directly paid to the policyholder's bank account.
   5. Waiting Period: The policy has a 30-day initial waiting period for all illnesses except for accidents.
      It also has a two-year waiting period for specific illnesses that require continuous coverage beginning 24 months from the policy's commencement and a three-year waiting period for pre-existing conditions that require continuous coverage for 36 months starting from the policy commencement date.
   6. Claim Settlement Ratio: This insurance is a trustworthy choice for buying health insurance online because of its claim requests with a claim ratio of 100%.
   7. Other Features: The plan covers various medical expenses up to the sum insured amount, including day-care procedures, domiciliary hospitalisation, organ donor expenses, AYUSH benefit and emergency ambulance expenses. 
4. Bajaj Allianz Health Guard Plan: This plan offers coverage for OPD expenses, including consultations, diagnostic tests, prescription drugs and hospitalisation benefits. Here are some of the highlights of this insurance plan:
   1. Sum Insured: The policy has three plans — Silver, Gold and Platinum.
      The Health Guard-Silver Plan offers a sum insured of INR 1.5/2 lakhs, while the Health Guard-Gold Plan ranges from INR 3 lakhs to INR 50 lakhs.
      The Health Guard-Platinum Plan provides sum insured options from INR 5 lakhs to INR 1 crore.
   2. Eligibility: This provides coverage for individuals falling under various age brackets.
      The proposer, spouse, parents, sister, brother, parents-in-law, aunt and uncle are eligible for coverage between the ages of 18 and 65 years.
      Additionally, dependent children and grandchildren aged between 3 months and 30 years can also be covered under the policy. 
   3. Network Hospitals: It has an extensive network of hospitals, with over 6,500+ hospitals tied up with the insurance company. 
   4. Claim Process: This offers its policyholders a simple and hassle-free claim procedure. You can start a claim by phoning their toll-free number or using their website.
      The policyholder can provide the necessary paperwork, which includes medical records, bills and discharge summaries after the claim has been registered.
      If the claim is accepted, Bajaj Allianz will pay the hospital directly. The insured may submit all required paperwork and invoices for reimbursement claims to be approved. 
   5. Waiting Period: The waiting period of the Bajaj Allianz Health Guard insurance plan varies based on the type of illness or condition.
      Generally, a waiting period of 30 days is applicable for any illness except in case of accidental injuries. A waiting period of 24 months is applicable for pre-existing diseases.
   6. Claim Settlement Ratio: The claim settlement ratio for the Health Guard Policy of Bajaj Allianz is 96.59%.
   7. Other Features: It covers pre- and post-hospitalisation expenses, offers a no-claim bonus, restoration benefit, and maternity and newborn baby cover.
      The policy also covers medical expenses incurred for AYUSH treatments up to the sum insured limit.
5. ICICI Lombard Complete Health Insurance: This plan provides coverage for OPD expenses, including consultations, diagnostic tests and medicines, hospitalisation expenses, and other benefits. Some of the top features are as follows:
   1. Sum Insured: ICICI Lombard Complete Health Insurance plan covers up to INR 10 lakhs.
   2. Eligibility: The proposer must be 18 years old, and the senior-most person to be insured should be between 5 and 60 years of age.
   3. Network Hospitals: This provides a cashless claims facility at over 4,000 network hospitals across India. This facility can be availed in case of planned or emergency hospitalisation by using the health card at the network hospitals.
   4. Claim Process: ICICI Lombard Health Care, the company's claim processing portal, handles the claims. Use the health card to avail of cashless hospitalisation at network hospitals during planned or emergency hospitalisation.
      The policyholder must notify the insurer of the claim 48 hours before hospitalisation for planned hospitalisation and within 24 hours for emergency hospitalisation.
   5. Waiting Period: The initial waiting period for this particular insurance is 30 days for all illnesses (apart from those brought on by bodily injury). 
   6. Claim Settlement Ratio: The insurance company has resolved 93.10% of all claims filed. 
   7. Other Features: It provides comprehensive health insurance coverage with a vast network of hospitals for cashless treatment, coverage for pre-existing diseases, day care procedures, maternity and newborn baby cover, alternative treatment coverage, and health check-ups.
      Moreover, policyholders can earn a no-claim bonus if they do not file any claims during the policy year. 
6. Apollo Munich Maxima Health Plan: The Apollo Munich Maxima Health Plan is a thorough health insurance plan meant to cover a variety of medical expenditures.
   It provides a range of advantages, such as hospitalisation coverage, daycare operations, pre- and post-hospitalisation expenditures, and ambulance fees.
   1. Sum Insured: The Apollo Munich Maxima Health Plan provides coverage of up to INR 3 lakhs per policy.
   2. Eligibility: For Apollo Munich Maxima Health Insurance, individuals can be enrolled from as early as 91 days of age up to a maximum age of 65.
   3. Network Hospitals: Apollo Munich Maxima Health Insurance offers access to over 4650 network hospitals for cashless medical treatment.
   4. Claim Process: In case of hospitalisation, the insured individual can inform the insurance company or the third-party administrator (TPA) within 24 hours of hospitalisation. The claim can then be initiated either as a cashless or a reimbursement claim. 
   5. Waiting Period: The Apollo Munich Maxima Health Plan does not cover any treatments during the first 30 days, apart from accidental injuries. Pre-existing conditions won't be covered until three years have passed following the waiting period. 
   6. Claim Settlement Ratio: The Apollo Munich Maxima Health Plan has a claim settlement ratio of 89%.
   7. Other Features: The Apollo Munich Maxima Health Plan offers comprehensive coverage for hospitalisation exceeding 24 hours.
      This includes medical expenses for pre- and post-hospitalisation that has a period of up to 60 and 90 days, respectively. The plan also covers 140 daycare procedures.
7. Cigna TTK ProHealth Accumulate Plan: Cigna TTK ProHealth Accumulate Plan is a comprehensive health insurance plan designed to provide coverage for a range of medical expenses.
   The plan offers a unique feature of 'ProHealth Rewards' where a policyholder can earn reward points for maintaining a healthy lifestyle, which can be redeemed for various benefits. There are various features to talk about, which include:
   1. Sum Insured: This policy provides a base cover ranging from INR 5,50,000 to INR 25,00,000.
   2. Eligibility: This offers health insurance coverage for individuals across all age groups. The policy has a minimum entry age of 91 days for children and 18 years for adults.
      Unlike some health insurance plans, this policy has no maximum entry age, making it an attractive option for individuals of all ages.
   3. Network Hospitals: The Cigna TTK ProHealth Accumulate Plan provides cashless treatment at over 7500 hospitals.
   4. Claim Process: It offers a helpline to guide customers through the claim processes.
      For planned hospitalisation, it is recommended to notify the company at least 3 days in advance, while in the case of emergencies, the company should be notified within 48 hours.
      If cashless treatment is preferred, customers can contact the helpline to request pre-authorisation. 
   5. Waiting Period: In the Preferred and Premier plans, pre-existing diseases are not covered for 24 months, while in the Accumulate plans, coverage for pre-existing diseases begins after 36 months. For the Protect plan, the waiting period is 48 months. 
   6. Claim Settlement Ratio: ManipalCigna's settlement ratio of 91% makes it a reliable option for health insurance. 
   7. Other Features: This health insurance plan offers pre-hospitalisation coverage for up to 60 days, post-hospitalisation coverage for up to 90 days, and ambulance expenses of up to INR 2000 per event.
      It provides room rent coverage of up to a single private room for certain sums insured and offers a Cumulative Bonus of 5% with a maximum rate of 200% of the sum insured.
      The plan also offers unlimited times of restoration with a 100% additional sum insured for unrelated illnesses, injuries or accidents.

It is crucial to note that the availability and features of these plans may vary depending on the insurer, the policy and the location. It is advisable to read the policy documents carefully and compare the benefits and premiums of different health insurance plans before making a decision.

The coverage for health insurance with OPD cover may be influenced by several factors. It is crucial to understand them and their impact on OPD coverage. Below mentioned are the factors affecting health insurance coverage with OPD coverage in India. 

1. Type of health insurance policy: The type of health insurance policy chosen can impact the extent of OPD coverage offered. Comprehensive plans usually offer wider coverage for OPD expenses, while basic plans may offer limited or no coverage.
2. Premiums: The premium amount paid may affect the coverage offered for OPD expenses. Plans with higher premiums may offer wider coverage, while plans with lower premiums may offer limited coverage.
3. Deductibles and co-payments: Many health insurance plans with OPD cover come with a deductible and co-payment clause, which require the policyholder to pay a certain amount out of their pocket.
   Higher deductibles or co-payments may result in less coverage for OPD expenses.
4. Provider network: Health insurance plans with OPD cover may have a provider network that offers coverage only for certain hospitals, clinics and healthcare providers.
   Policies with a more extensive network of providers may offer more options for OPD visits and provide more comprehensive coverage.
5. Pre-existing conditions: Pre-existing medical conditions may impact the coverage offered by health insurance plans with OPD cover. Some plans may offer limited or no coverage for pre-existing conditions, while others may require a waiting period before coverage can be offered.
6. Age and health status: The age and health status of the policyholder may also impact the coverage offered.
   Plans may offer wider coverage for younger and healthier individuals, while coverage for older individuals or those with pre-existing conditions may be limited.
7. Geographical location: The geographical location of the policyholder may also influence the coverage as some plans may offer limited coverage for healthcare expenses incurred outside of a certain region or country.

Health insurance plans that include an outpatient department (OPD) cover can offer several advantages to policyholders, as detailed below:

1. Patients who require frequent hospital visits for OPD consultations, even for minor ailments like viral fever, can benefit from OPD coverage. The coverage can help offset the costs of such consultations and treatments, resulting in significant savings for the policyholder.
2. The policyholder can be reimbursed for the high costs associated with purchasing medicines from a pharmacy, as an OPD cover can provide adequate financial protection against such expenses.
3. An OPD cover particularly benefits those patients suffering from pre-existing medical conditions that require frequent medical consultations.
   By covering the costs of these consultations, the policyholder can ensure access to necessary medical care and attention without having to worry about the financial burden.
4. Individuals who are immunocompromised due to various health factors may also find an OPD health cover beneficial. Regular consultations with medical professionals can help them manage their health better and minimise the risk of complications.

When considering selecting a health insurance plan with OPD cover, there are several factors to take into account. Some of these are listed below:

1. Understand your needs: It’s important to ensure that the plan you choose covers all the medical services and treatments you require.
   This will involve evaluating the frequency of OPD consultations you need, the type of medical conditions you have, and the medication you require.
2. Coverage details: Checking the coverage provided by the plan is another important factor. You should opt for a health insurance plan that provides comprehensive coverage, including hospitalisation and OPD expenses.
   This involves carefully reviewing the inclusions and exclusions of the policy to ensure that it covers all the medical services and treatments you need.
3. Plans comparison: Comparing multiple health insurance plans with OPD cover offered by different insurers lets you know of different options available.
   This involves considering factors such as premiums, benefits, waiting periods, network hospitals, and claim settlement ratios. By comparing different plans, you can find a policy that best meets your needs.
4. Checking limits: Finding a policy that provides adequate coverage limits for OPD consultations, diagnostic tests, and medications is essential.
   You should also check the co-payment clauses and deductibles that may apply to OPD expenses.
5. Expert advice: It is always advisable to consult a financial advisor or an insurance expert who can guide you in selecting a suitable health insurance plan with OPD coverage.
   They can help you understand the nuances of different policies and assist you in making an informed decision.

Health insurance with OPD coverage can provide much-needed financial support for individuals and families seeking outpatient medical services. However, it's important to carefully consider factors such as type of policy, premiums, deductibles, provider network, pre-existing conditions, age, etc. when selecting a plan that meets your needs. It's also crucial to understand the criteria for coverage, as well as the claim process. With the right health insurance plans with OPD cover, you can rest assured that you are taking proactive steps towards protecting your health and financial future.

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