Family Health Insurance

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Although in-patient medical expenses tend to be remarkably higher, Outpatient expenses can accumulate over the year and become too expensive for individuals and families. The survey conducted by ET Prime concluded that almost 62% of healthcare expenses in India are towards Out-Patient Department (OPD) costs. Thanks to health insurance policies with OPD benefits or coverage, hospitalizations are no longer mandatory. Here is the article that helps you to tap into the complete benefits of the feature.

What is Outpatient Consultation in Health Insurance?

 Not all medical issues require hospitalization, sometimes a minor illness or injury requires visiting the OPD. With the standard health insurance policy or a mediclaim policy, a minimum of 24 hours of hospitalization is compulsory. However, with OPD coverage, the policyholders can go ahead with outpatient treatments such as visits to a physician’s office, clinics, or other healthcare facilities for diagnostic, treatment, or preventive care without any financial worries.

Who can avail of health insurance plans with OPD coverage?

  • Health insurance OPD coverage is ideal for the age group of people between 25 to 40 years, considering the frequent doctor consultation visits that don’t require
  • The patients with chronic ailments such as Asthma, Diabetes, Thyroid etc. In this, outpatient consultations, the medicines required etc, are financially covered, which helps the policyholders conveniently access premium healthcare services without any financial impact.
  • Individuals who have nominal ailments such as fever and cold also can benefit from OPD coverage, considering they do not require any hospitalization.

Inclusions of an OPD Health Insurance Policy

 Here are the coverage details of OPD covered in the health insurance policy:-

  • Doctor Consultations
  • Diagnostic tests
  • Pharmacy expenses
  • Investigate test charges

Exclusions of an OPD Health Insurance Policy

 Here are the exclusion details of OPD coverage in a health insurance policy:-

  • The costs of spectacles, lenses, implants, hearing aids, prosthetic devices, braces, etc.
  • OPD treatment outside India.
  • Routine examinations or preventive health checkups.
  • Vaccination is also included such as immunisations except in case of post-bite treatment such as a dog bite.
  • Sterility, infertility, and other related
  • Dentures, dental treatment, or any kind of
  • Complications arising out of pregnancy, miscarriage,
  • Investigational treatments or experiments.
  • Treatments for beautification, purification, detoxification, panchakarma,

Note:- Regarding the inclusions and exclusions of OPD health insurance policy, there is a variation depending on the health insurance provider and the type of health insurance policy availed.

Features of OPD Coverage in Health Insurance

The features of outpatient consultation (OPD) coverage in health insurance plans may vary depending on the specific policy and insurance provider. However, some common features include:

1.   Coverage for diagnostic tests and procedures

Outpatient consultation coverage typically includes coverage for diagnostic tests and procedures, such as X-rays, blood tests, and ultrasounds.

2.   Coverage for consultation fees

OPD coverage may also cover the cost of consultation fees with healthcare professionals, such as physicians and specialists.

3.   Limits on coverage

Although insurance plans may have limits on the number of consultations or diagnostic tests that can be covered under the OPD benefit.

4.   Network restrictions

Some insurance plans may also restrict the choice of healthcare providers for OPD coverage to a specific network of providers.


Health insurance is crucial and having appropriate coverage is equally important. Get a large cover for your family by buying the family health insurance policy or mediclaim policy for your family from SecureNow. Furthermore, we offer group health insurance for employees from leading private and public sector companies. Contact us for a quick access to insurance related information.

About The Author


MBA Insurance Management

Pooja is a dedicated professional with 7 years of experience in the insurance industry, specializing in Family Health Insurance. Writing for SecureNow, she offers insightful blogs and articles aimed at simplifying the complexities of health insurance for families. Her expertise ensures that readers gain practical, easy-to-understand advice on choosing the best coverage to protect their loved ones. Committed to making informed decisions accessible, Pooja stays updated on industry trends and developments, providing valuable content that empowers families to secure their health and financial well-being.