Can health insurance cover OPD costs like cold, fever, and throat infections? Expert answers

Q. I often fall ill during the rainy season with cold, fever or throat infections. Is there any health insurance that covers doctor consultations and medicines without the need for hospitalisation?

Amarnath Saxena, Chief Technical Officer- Commercial, Bajaj Allianz General Insurance, answers: 

It is common to experience seasonal ailments like cold, fever, and throat infections during the rainy season. While these illnesses usually don’t require hospitalisation, they do involve frequent visits to doctors, regular medications, and sometimes diagnostic tests, all of which can lead to recurring out-of-pocket medical expenses. The good news is that there are health insurance plans available in the market that cater specifically to such needs by offering Outpatient Department (OPD) cover, which is designed to cover medical expenses incurred without the need for hospital admission.

OPD cover refers to insurance that helps you manage expenses related to medical consultations, prescribed medicines, and basic diagnostic tests, without the need for hospital admission. This type of coverage is ideal for individuals who may not require inpatient care but do need frequent outpatient treatment. If you are prone to seasonal illnesses or have minor recurring health issues, opting for a health insurance plan with OPD benefits can be a cost-effective and convenient solution.

Many insurers offer OPD cover as an optional add-on to a base health insurance policy, while a few comprehensive plans come with OPD benefits built in. Some even provide standalone OPD insurance policies that focus entirely on covering outpatient healthcare costs. Typically, these policies have an annual limit, meaning you can claim OPD expenses up to a certain amount within a policy year. For instance, if your plan offers ₹5,000 as OPD cover, you can use that amount across multiple consultations, medicine purchases, or basic tests during the policy period.

Regarding claims, some insurers provide cashless OPD services at specific network clinics, pharmacies, and diagnostic centres. Others may require you to pay first and then submit your bills for reimbursement. Another useful feature to look out for is coverage for teleconsultations or online doctor consultations, which is increasingly being included in many health insurance plans. This can be especially helpful when dealing with minor illnesses, as it allows you to consult a doctor remotely from the comfort of your home.

A health insurance plan with OPD coverage is a valuable solution for managing seasonal and recurring health issues without the need for hospitalisation. It helps reduce the financial burden of routine medical expenses and ensures that you don’t postpone necessary treatment due to cost concerns. When selecting a plan, be sure to compare features such as annual OPD limits, claim processes, network availability, and additional benefits like teleconsultations. With the right OPD-inclusive health insurance, you can manage seasonal illnesses more efficiently and focus on staying healthy.

Views are personal