Health insurance is an important necessity that provides coverage for hospitalisation and other related expenses in case of medical emergencies. When you select a health insurance plan, it is important to understand two important terms of medical services – OPD and IPD. OPD covers day-to-day healthcare needs like doctor consultations, minor treatments, and diagnostic tests that don’t necessitate hospitalisation. While IPD deals with expenses incurred during hospital stays, such as treatments or surgeries requiring admission. Knowing this scope of medical services can help you choose a policy that aligns with your medical needs, ensuring complete protection.
IPD Full Form – In-Patient Department
In-patient department expenses include healthcare expenses for treatments that require hospitalisation for at least 24 hours. Generally, all standard health insurance plans cover in-patient department expenses. Individual insurance and family health insurance both provide coverage for in-patient department expenses. The coverage typically includes:
- Room rent and doctor fees
- Nursing charges
- Surgical procedures cost
- Medicine expenses and tests
- Pre-hospitalisation (usually 30 to 60 days before admission) and post-hospitalisation expenses (usually 30 to 90 days after discharge)
- Critical care, surgeries, and prolonged illnesses that require days of hospital stay.
OPD Full Form – Out-Patient Department
Out-patient department expenses include medical expenses for treatments where hospitalisation is not required. Generally, standard health insurance policies may not provide coverage for out-patient expenses. However, some insurance companies offer out-patient care insurance policies and also add-ons to cover the out-patient department expenses. These policies cover:
- Doctor consultation fees
- Treatment expenses
- Diagnostic tests, scans, and X-rays
- Physiotherapy and other minor procedures that do not require overnight stay at the hospital
- Ongoing treatment of chronic diseases
Difference Between IPD and OPD in Health Insurance Coverage
| In-patient department | Out-patient department | |
| Coverage | In-patient service costs such as room rent, boarding charges, nursing charges, ICU, surgeries, etc. | Out-patient service costs such as doctor consultation fees, diagnostic tests, scans, and medicine expenses, etc. |
| Hospitalisation | At least 24 hours of hospital stay | No hospital stays |
| Claim amount | Higher claim amounts due to hospitalisation | Claim amounts can be lower however the frequency of claims can be higher |
| Claim Process | Cashless claims through network hospitals and can also be reimbursed | Reimbursement claims |
| Premium | IPD expenses are typically covered by standard health insurance policies and hence the policy premium is paid towards IPD | Not covered in standard health insurance policy. May require an add-on that costs an extra premium. |
| Importance | Essential to cover medical emergencies and high-cost surgeries | Beneficial for routine check-ups and for smaller and more frequent claims. |
Covering all types of medical services makes the health insurance policy comprehensive. Choosing the best health insurance policy requires careful consideration of various factors. You need to first evaluate your healthcare needs, including family medical history, pre-existing conditions, age, etc. Look for comprehensive personal insurance that covers in-patient, out-patient, and critical illnesses. Review policy inclusions and exclusions before you choose the policy that suits your needs and budget.
Conclusion
To sum up, in-patient department expenses and out-patient expenses are two different medical services that are differently treated when it comes to health insurance coverage. IPD expenses are generally covered in the standard health insurance policy that is essential for medical emergencies and high-cost treatments. On the other hand, OPD cover comes as an add-on and is beneficial for smaller but frequent claims. Understanding the difference helps you make a rational choice based on your needs.
Frequently Asked Questions (FAQs)
Q) Is OPD cover included in all health insurance policies?
A) No, OPD coverage is not typically included in standard health insurance policies. Only a few premium plans cover OPD expenses and some policies also include them in add-ons.
Q) Are pre-existing conditions covered under IPD and OPD health insurance cover?
A) Pre-existing conditions are typically covered after a waiting period of 24 months to 48 months, varying from insurer to insurer. Check the policy terms and conditions to understand the pre-existing illness exclusions.
Q) Does IPD cover daycare treatments?
A) Yes, most of the health insurance policies with IPD cover include daycare treatments that do not require a 24-hour hospital stay. This includes chemotherapy, cataract surgery, etc.
