Health insurance typically covers medical expenses and hospitalisation for most illnesses. Even heart attacks and other serious conditions get covered. However, there are some health conditions and treatments that are usually not covered by it. In fact, many of them didn't get covered until recently. This makes one wonder – Does health insurance cover dental and eye care?
It may be noted that regular health insurance primarily covers hospitalisation expenses (including pre- and post), whereas OPD coverage, also known as Outpatient Department coverage, provides added benefits by covering medical expenses that occur without hospitalisation. It provides broader coverage for medical expenses and brings added value to your standard health insurance policy.
Are OPD Expenses Covered?
OPD expenses are not covered by most health insurance policies in their base policies. However, there are still a few health insurance plans available in the market that cover OPD expenses in their base policies. It, however, may vary from insurer to insurer and plan to plan.
"With a standard health insurance policy, dental treatments are mostly excluded. The coverage for eye care typically includes treatments of cataracts and eye injuries. OPD coverage can be included in your base health insurance plan through either a rider or an add-on," says Amarnath Saxena, CTO-Commercial, Bajaj Allianz General Insurance.
Additionally, there are some insurers that are offering 2x OPD Cover, which proves to be beneficial for policyholders. It is essential to understand your requirements and then seek a suitable OPD coverage.
What's Covered
OPD usually covers fees for doctor visits, as well as costs for diagnostic tests such as blood tests, x-rays, and MRIs, among others. The cost of prescribed drugs and small treatments, along with physiotherapy visits and additional related costs, can be covered by it.
How To Make A Claim
OPD works by filing a reimbursement for medical expenses (that are covered) on an OPD basis. Insurance providers, along with the app, allow policyholders to submit their bills and doctors' prescriptions for medical expense claims. Some insurers also provide cashless OPD services within their network of doctors, hospitals, or labs. It simplifies the process for policyholders.
Limitations Of OPD Coverage
The OPD cover is useful as it offers numerous benefits, but it is also essential to understand its limitations before opting for it.
"Most plans with OPD have a waiting period after which the policyholder can use the benefits. It also may come with sub-limits on the amount. It means it can limit the amount that can be claimed for specific services," informs Saxena.
Certain medical costs will not be covered through the plan. The knowledge of specific coverage details and exclusion points will help you select the best OPD coverage for extended advantages.
How To Choose The Right Cover
"To choose the right OPD cover, apart from understanding the coverages, one must also consider the availability of cashless services for a smooth process, network hospitals, doctors, and labs for easy access, and compare premiums for OPD cover with different insurers," says Saxena.
Keeping all these factors in mind, you will likely find the right OPD cover that suits your unique requirements.
