Understanding Mediclaim Policy With OPD Coverage


By OPD we basically refer to the Out-Patient Department of a hospital. Sometimes a patient’s ailment is resolved by the doctor without any requirement of getting hospitalized. Under these circumstances, the patient is said to get the OPD treatment. These may involve routine visits to the clinic, diagnostic tests, monthly check-up, etc. A Mediclaim policy with OPD coverage is essential due to the inflation in the medical expense.

Many health insurance plans give OPD coverage that is availed with ease through cashless claim settlement. Insurers have hospitals within their network that can provide OPD coverage even for pharmacy bills. By opting for a Mediclaim policy with OPD coverage, one can optimize their medical expenditure. In today’s era, it is commonly seen that erratic health issues obstruct our daily routine. Hence, one must be aware of what is OPD coverage in insurance. For instance, dental appointments can be considered as OPD treatment. In most scenarios, patients are never required to get admitted for a root canal.


Irregular sleeping patterns and unhealthy eating habits have corrupted the modern lifestyle. Thus, individuals have become more prone to frequent illnesses and minor health-related issues. Herein lies the significance of a Mediclaim policy with OPD coverage. It saves you the trouble of paying incessantly for all your monthly visits to the clinic or hospital. One also needs to understand what is OPD coverage in insurance, before applying for it.

A health insurance policy with OPD coverage covers extra expenses incurred apart from hospitalization. Policyholders can claim extra tax benefits with such plans. No Tax Deductible at Source (TDS) is applicable for such claims.

Insured members can claim reimbursements for medical treatments even successively. A Mediclaim policy with OPD coverage optimizes the utility of the sum insured. The claim settlement for ordinary health insurance plans is determined by 24 hours of hospitalization. In case of plans that give OPD coverage, it is based on the member’s age. Even the waiting period for such plans is lower. One can claim the insurance for OPD coverage within 90 days of initiation of the policy.


The Mediclaim policies with OPD coverage offer the following benefits:

• It provides financial coverage for medical needs such as dentures, spectacles, crutches, etc. Under Section 80D of Income Tax, the policyholder can also avail tax benefits.

• Pre and post maternity treatment benefits are covered under some of the health insurance plans with OPD coverage.

• If the OPD coverage is not utilized during one policy year, the sum will be carried forward. The insured can get 50-80% of the insurance as an extra benefit in the subsequent policy year. The amount of benefit received depends upon the plan opted for.

• Some plans also give personal health wallet benefit. It basically involves paying insurance in portions for the OPD coverage. The options for insured amount are worth INR 5000, INR 10000, INR 15000 and INR 20000.

• All the pharmacy bills should be duly collected and stored by the insured member. This way they can rightfully claim the insurance.


ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address –
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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