A quick visit to the doctor for common ailments like flu, eye infections, ear pain, or even a minor injury may seem like a small expense at first.
But when you add up frequent consultations, diagnostic tests, and medicine bills over the course of a year, these costs can take up a significant portion of your salary. A health insurance plan with an Outpatient Department (OPD) benefit can help in saving on routine medical visits and manage healthcare expenses more efficiently.
“Traditionally, insurance has covered only hospitalisation. This is because insurance, by definition, is meant for low-frequency and high-severity use cases. OPD is exactly the opposite! In a way, OPD plans are more “health savings plans”, said Shashank Avadhani, Co-Founder & CEO, Alyve Health.
While a common perception limits the scope of health insurance to only cover expenses on hospitalisation, there has been a significant shift in preferences among customers over the years. The percentage of OPD add-ons has increased phenomenally from 5% in financial year 2022-23 (FY23) to 22% in financial year 2025-26 (FY26), according to a PolicyBazaar.com report. As per the PB data, one in five health policies now include OPD cover.
Why Is OPD Insurance Plan Gaining Popularity Among Indians?
Rising awareness, shooting medical inflation, and expanded scope are among the key reasons behind the rising popularity of health insurance plans with OPD cover. While some base health insurance plans offer an OPD rider, buyers can also purchase an add-on OPD insurance cover above their base plan.
These OPD insurance plans offer a frictionless experience, with app-based claims, QR check-ins, and e-cards. In general cases, OPD coverage can go as high as Rs 1 lakh, which makes it more useful for high-frequency spenders and those who are on medications for illnesses like hypertension, diabetes, etc.
The OPD coverage in health insurance lets people engage with a doctor for consultation on illnesses and ailments that can grow severe due to negligence.
“Instead of waiting for hospitalisation to ‘use’ their cover, people are now engaging multiple times a year for doctor visits, medicines, or diagnostics. This makes health insurance tangible, relevant, and rewarding in daily life,” stated Siddharth Singhal, Head of Health Insurance, Policybazaar.
How To Choose The Right Health Insurance With OPD Cover?
People must consider a host of factors, including ease of access, preventive coverage, exclusions, and technology nudges etc, while choosing the right OPD cover for themselves. Shashank Advani highlights these four crucial factors people must consider while choosing an insurance plan with an OPD benefit.
Plan Coverage
Some OPD riders and add-ons offer limited number of free clinic visits in a year, some offer low coverage. People must choose an OPD rider or add-on that meets their family’s healthcare needs.
“Is the plan meeting your family’s healthcare needs – (e.g. a young family may need coverage around maternity and children vaccinations),” noted Advani.
Ease of Access
Make sure that the OPD plan not only covers clinic visits, but also diagnostics like blood tests and other checkups. Certain health insurance plans also offer cashless, instant and frictionless purchase of medicines.
Preventive Coverage
“It’s not just about the cure. Good OPD coverage should include multiple preventative and proactive use cases like diagnostics, physiotherapy, mental wellness, dental care, and even nutrition because these are the everyday levers of long-term health,” noted Advani.
Wellness Programs
Some health insurance plans also offer benefits on leading a healthy lifestyle. “The real value of OPD coverage is in early detection and proactive care. If a health plan nudges you towards regular check-ups, lifestyle tracking, or wellness programs, that’s a sign that the technology is user-centric,” Advani added.
Policy Exclusions
At last, it is crucial for customers to carefully read and understand policy exclusions. For example, some health insurance plans do not cover dental check ups, others do not offer check-ups for multivitamin deficiency. Policy exclusions vary from plan to plan, and people must understand them to avoid last minute expenses.
OPD Insurance Plans
OPD insurance plans are generally available as an add-on to a base health insurance plan which mainly covers hospitalisation expenses. Here are OPD insurance plans and there premium, as per Policybazaar analysis.
| Insurer | ICICI Lombard | Bajaj Allianz | Niva | Niva | Star Health Insurance |
| Plan Name | Elevate | My Health Care | Aspire | ReAssure | |
| Rider Name | OPD+ | Health Prime | Well Consult-OPD | Acute-Best Care | OPD Care |
| Claim Type | Cashless | Cashless and Reimbursement | Cashless and Reimbursement(20% Co-Pay on Reimbursement) | Cashless and Reimbursement | CashlessReimbursement for accident related emergency |
| In Clinic | Upto SINo Sub-Limits
Dental / Vision / Minor Procedure without any Sub-Limits |
Rs. 15k for IndivisualRs. 25k for FF | Rs. 10,000 | NA | upto SI |
| Diagnostics | Rs. 10,000 | Upto SI | |||
| Pharmacy | NA | Rs. 2,500 | |||
| PED Waiting Period | 30 Days | 30 Days | 3 Years | As per Base Plan Waiting Period | 1 Year to 3 Year |
| Premium for 1A 35 Delhi | Rs. 4,980 (For 10k SI) | Rs. 2,062 (For 15k SI) | Rs. 5,730 (For 22.5k SI) | Rs. 4,801 (For 10k SI) | Rs. 4,802(for 25k SI) |
| Premium for 2A 35-33 Delhi | Rs. 5,819 (For 10k SI) | Rs. 4,870 (For 25k SI) | Rs. 5,730 (For 22.5k SI) | Rs. 6,254 (For 5k SI Per member) | Rs. 6,336 (for 25k SI) |
| Other Features | Dental / Vision / Minor Procedure w/o Sub-LimitsSpectacles and Lenses cost also covered once per policy term | NA | 10 Session of Emotional WellnessUnlimited Diet/Nutrition Coaching and AI Smart Fitness Coaching
Gym Membership with 2 visits / week / adult |
NA |