Health Insurance With OPD On Rise In India! 5 Tips To Pick Best Plan To Cover Clinic Visits, Pharmacy Bills

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 Avadhani 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 Avadhani.

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 Avadhani.

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," Avadhani 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	Cashless Reimbursement for accident related emergency
In Clinic	Upto SI No Sub-Limits Dental / Vision / Minor Procedure without any Sub-Limits	Rs. 15k for Indivisual Rs. 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-Limits Spectacles and Lenses cost also covered once per policy term	NA	10 Session of Emotional Wellness Unlimited Diet/Nutrition Coaching and AI Smart Fitness Coaching Gym Membership with 2 visits / week / adult	NA	Dental(for natural tooth or teeth arising out of accidents incurred at any Networked Facility in India as an Outpatient) Vision (Arising out of accident incurred at any Networked Facility as an Outpatient) 10-15% Medicine Discount 15-30% Diagnostics Discount