>> Health insurance policies which cover out-patient Benefit

Health insurance policies
which cover out-patient Benefit

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    Health Insurance Plans with OPD Cover in 2022


    Check out the table below with different health insurance plans with OPD cover from different health insurers in India



    OPD Health Insurance Plan

    Sum Insured (Rs.)

    Entry Age Criteria (yrs.)

    OPD Cover

    Aditya Birla Active Health Platinum Enriched Insurance Plan Rs 3 crore - Rs 6 crore Min- 5 years in individual plan Min- 91 days in family floater OPD Limit - Rs.10,000
    Bajaj Allianz Tax Gain N/A 18-75 years OPD hospitalization expenses under a single policy
    Star Outpatient care insurance policy Rs. 25,000 to Rs.1,00,000 18 - 50 years OPD cover at all Network facilities
    Niva Bupa Go Active Health Insurance Plan Rs 4 lakh- Rs 25 lakh 18-65 years OPD Limit- 25 lak
    Aditya Birla
    Activ Health Platinum
    Enriched Insurance Plan




    Eligibility

    Minimum Entry age- 18 years
    Maximum Entry age- 75 year

    Family size

    An individual + spouse

    Sum insured option

    Floater Sum Insured Rs 2 lakh

    Coverage

    The policy will cover the costs incurred for medically necessary consultations , diagnostic tests, and pharmacy expenses on an out-patient basis up to the amount specified under the policy. The appointments can be scheduled through the website or through the mobile application or call the toll free number to schedule the appointments.

    • The expenses incurred on outpatient consultations by a general medical practitioner/ specialist medical practitioner. A maximum of 10% of the sum insured would be covered for every consultation.
    • Outpatient diagnostic procedures in case of road traffic accident as prescribed by the medical practitioner up to a maximum of Rs.10,000 over and above the OPD limit as mentioned in the policy
    • If the insured has not utilized the sum insured completely under the policy then the unutilized sum insured would be carried forward to the next policy year, and should be utilized within 12 months after carried forward to the next year.
    • Outpatient diagnostic tests or medicines purchased from the pharmacy as prescribed by the medical practitioner would be covered up to a maximum of 50% of the limit specified under the policy schedule for OPD expenses
    • These services can be availed at the network hospitals on a cashless basis. If these services are available at a non network hospital then the insured can go for reimbursement basi

    OPD Bonus on Unutilized OPD Expenses

    The company will add a OPD Bonus of 5% to the unutilized OPD expenses at the end of the policy period, provided that

    • The OPD bonus would apply even if claims are made under other benefits of the policy
    • The OPD bonus will not apply if the policy is not renewed within the grace period
    • OPD bonus would be calculated on the unutilized OPD expense
    • The OPD bonus is not applicable on the unutilised limit for road accident diagnostic.

    Conditions

    The OPD benefits shall be available on an individual basis to each eligible insured person up to the limit
    specified in the policy for an individual policy as well as floater policy. The limit for OPD expenses under this policy
    for each insured person shall remain the same in case of a family floater policy.

    Bajaj Allianz
    Tax Gain






    Eligibility

    Minimum Entry age- 18 years
    Maximum Entry age- 75 years

    Family size

    An individual + spouse

    Sum insured options

    Floater Sum Insured Rs 2 lakh

    Coverage

    The policy will cover the outpatient medical expenses in case of treatment required on an outpatient basis on the advice of any medical practitioner because of illness or accidental bodily injury during the policy period. The policy will pay the reasonable and customary out patient expenses incurred by the insured subject to the maximum limit of indemnity as mentioned in the policy.

    Waiting period

    There are certain waiting periods under the policy which are mentioned below


    Cost of spectacles is not paid in the first year of the policy. The cost of spectacles is paid in the second year of continuous renewal subject to a maximum of 25% of the OPD limit

    Cost of hearing aids in the first 2 years of the policy. The cost is paid in the third year of continuous renewal subject to a maximum of 25% of the OPD limit.

    Cost of dentures in the first 2 years. The cost is paid in the third year of continuous renewal subject to a maximum

    Specific Exclusion

    Any expenses for treatment which is taken without a doctor’s prescription or advice Any expenses for diagnosis tests without the treating doctor’s referral Cost of annual health checkup Any expenses in excess of the maximum payable under the outpatient medical expenses limit.

    Star Outpatient care
    insurance policy






    Eligibility

    Minimum Entry age- 18 years
    Maximum Entry age- 50 year

    Family size

    Up to 6 members, dependent children will be covered if any one of the parents are covered under the policy

    Sum insured option

    Rs. 25,000 to Rs.1,00,000

    • Outpatient consultation expenses incurred at any network facility in India
    • Dental treatment expenses to a natural tooth or teeth arising out of accidents at any of the network facilities in India as an outpatient.
    • Expenses incurred for diagnosis, physiotherapy and pharmacy at any of the network facilities in India for treatment as an outpatient.
    • Non allopathic treatment expenses such as expenses incurred on Ayurveda, Yoga, Unani, Siddha and Homeopathy in any institute recognized by the Government of India and or accredited by the Quality council of India/ National Accreditation board on health.
    • Ophthalmic treatment expenses arising out of accidents incurred at any network hospitals in India as an outpatient
    Niva Bupa
    Go Activ Health Insurance Plan






    Eligibility

    Minimum Entry age- 18 years
    Maximum Entry age- 65 year

    Family size

    Up to 2 Adults & 4 Children

    Sum insured option

    Rs. 4,00,000- 25,00,000

    Coverage

    The OPD consultation taken during the policy period will be covered subject to


    • The maximum number of consultations as specified in the policy schedule. The maximum number of OPD consultations under the policy is 10 depending on the number of members in the policy and the sum insured mentioned under the policy.
    • OPD consultation shall be requested through the mobile application or website
    • Any unutilized consultations cannot be carried forward to the next policy year.
    • There is no refill benefit available to the insured under the OPD expenses cover.
    • In case of reimbursement, the maximum amount would be the amount per consultation as
    • Treatment normally taken on an OPD basis cannot be included under the day care treatment.
    • OPD consultation can be availed either through a Cashless facility or on reimbursement basis through a network hospital. In case of reimbursement the maximum per consultation limit is Rs.600 for Zone 1 and Rs. 500 for Zone 2 coverage.
    • The number of consultations will be applicable for all the insured persons on a cumulative basis for the policy year.
    • There is no co-payment for the OPD expenses incurred under the policy
    • There are no waiting periods that are applicable under the policy
    • Reimbursement for OPD consultation shall be submitted within 30 days from the end of the policy year.