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OPD-inclusive health insurance in India now covers everyday medical costs like consultations and medicines, making proactive care affordable and reducing out-of-pocket spending.
Insurance
For too long, health insurance in India has operated under a simple premise: it’s there for when things go critically wrong. We dutifully pay our premiums, securing a safety net for the dreaded emergency, whether it’s a massive hospital bill, a sudden surgery, or a stay in the ICU. But what about the day-to-day reality of healthcare? The expenses that, individually, seem small but collectively bleed our savings?
This is the gap that most traditional health policies used to overlook, the costs of outpatient care such as doctor consultations, diagnostic tests, and medicines that don’t require hospitalisation but are unavoidable. These non-hospitalisation expenses form a significant part of a household’s annual medical budget, yet they often go uninsured.
Encouragingly, that’s beginning to change. With the recent removal of GST on health insurance products, OPD-inclusive plans have become more affordable, bringing comprehensive protection within reach for more Indians. It signals a shift in how we think about healthcare coverage, beyond emergencies, towards everyday wellbeing.
The silent killer of savings
The standard health insurance policy is designed around hospitalisation. Most benefits kick in only when you’re admitted for at least 24 hours. But in reality, that’s only a portion of the total healthcare costs.
Consider pre- and post-hospitalisation expenses, consultations, scans, follow-up visits, and medicines, that often account for 15–25% of the total medical bill. A patient recovering from surgery might spend Rs 7,000–10,000 on follow-ups and tests in just a month. Similarly, an ageing parent managing hypertension or diabetes could easily spend Rs 12,000–15,000 annually on routine care, entirely out of pocket.
India’s high out-of-pocket healthcare spending of around ~60 per cent is no coincidence. We are covered for a heart attack but not for the monthly tests and medicines that could prevent one. That makes our health system reactive rather than proactive.
Shifting from reactive to proactive health
OPD coverage changes this equation. It upgrades health insurance from a fund of last resort into a partner in everyday health management.
The financial benefits are immediate. Regular consultations, diagnostics, and medicines become part of the insured ecosystem. For example, newer OPD riders now offer teleconsultations, unlimited general practitioner visits, and even discounts on pharmacy bills, all without requiring hospitalisation. Some plans provide coverage up to Rs 1 lakh in annual OPD benefits.
The cost of this added protection is also affordable. Depending on the insurer and sum insured, OPD riders can cost anywhere between Rs 3,000 and Rs 6,000 a year, often less than what an average household spends on doctor visits and medicines in just a couple of months. For families managing chronic conditions or those with elderly members who need ongoing medical supervision, that small addition to the annual premium can translate into significant savings over time.
Even something as routine as dental or eye care, often excluded from traditional policies, can be covered under the broader scope of enhanced OPD plans. But the real shift is behavioural. When people know their consultations and tests are covered, they are more likely to seek care early. That leads to faster intervention, fewer hospitalisations, and healthier outcomes overall.
Making the upgrade: What to look for
When evaluating OPD coverage, check whether the annual limit is sufficient to realistically cover your likely expenses on consultations, diagnostics, and medicines. Pay close attention to inclusions such as dental, eye care, teleconsultations, or even alternative therapies, since a broader scope increases the value of the plan. Finally, consider the claims process, cashless facilities at clinics and pharmacies are far more convenient than cumbersome reimbursement systems, and a technology-driven, seamless process can make all the difference in how effectively you can use your benefits.
The bottom line
Health is not defined by emergencies alone. Ignoring smaller, recurring costs undermines both your finances and your wellbeing. By opting for OPD coverage and ensuring your policy adequately covers pre- and post-hospitalisation costs, you’re not just protecting yourself from crises, you’re investing in continuity of care.
A few thousand rupees extra in premium can save several times that in annual expenses, while ensuring you stay proactive about your health rather than waiting for things to go wrong. The real question, then, isn’t whether you can afford OPD coverage—it’s whether you can afford not to have it.
It is authored by Siddharth Singhal, Head of Health Insurance, Policybazaar.
The views expressed in this article are those of the author and do not represent the stand of this publication.
October 12, 2025, 09:13 IST
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