I already have hospitalisation cover. Should I also buy OPD insurance, and what should I look for?

I already have a standard health insurance policy that covers hospitalisation. But my family spends a lot more on regular doctor visits, diagnostic tests, and long-term medicines than on hospital bills. These expenses often eat into our savings. Should I consider buying an OPD coverage plan plan in addition to hospitalisation cover? What benefits does it provide, how cost-effective is it, and what features should I look for when choosing the right policy?

Advice by Gaurav Dubey, Founder & CEO of Livlong 365

For years, health insurance in India was synonymous with hospitalisation. A middle-class family worried about the financial shock of a sudden surgery, accident, or critical illness, and a policy that covered hospital bills seemed sufficient. But today, the pattern of healthcare spending has changed. Families are not always drained by hospitalisation. Instead, they are quietly burdened by outpatient expenses—doctor visits, diagnostic tests, and long-term medicines—that recur month after month. It’s not unusual for these routine costs to exceed hospitalisation bills in a given year. For investors who already have standard health insurance, the question is natural: Should I also consider OPD insurance?

Why hospitalisation cover alone falls short

Traditional health insurance acts like a shield for big, unpredictable blows. But it rarely accounts for the everyday costs of staying healthy. Households now spend significantly on paediatric check-ups, dental visits, thyroid screenings, physiotherapy sessions, and ongoing medication for conditions such as diabetes or hypertension. A single MRI can run into tens of thousands, and medicines for chronic diseases may cost thousands every month. Without OPD coverage, families end up dipping into savings repeatedly, which undermines other financial goals.

How OPD coverage plan fills the gap

OPD (Outpatient Department) insurance is designed to cover these day-to-day costs. It provides protection for consultations, diagnostics, medicines, dental and eye care, physiotherapy, and even counselling for mental health. Unlike hospitalisation cover, which may be used once or twice in a year, OPD coverage plan matches how families actually consume healthcare—frequently and across diverse needs.

For an average household spending Rs 20,000–Rs40,000 annually on outpatient care, OPD cover can convert unpredictable out-of-pocket costs into structured, insured expenses. It also encourages preventive health behaviour. People are more likely to go for screenings or seek early treatment when they know costs are covered, which lowers the risk of serious conditions going undetected until they become expensive to treat.

An OPD plan

If you are considering OPD coverage, the key is to pick a plan aligned with your family’s needs. Strong coverage for doctor visits, diagnostics, and medicines is essential, since these form the bulk of recurring spending. A wide cashless network of hospitals, clinics, and pharmacies reduces hassle. Pay close attention to exclusions—waiting periods, caps on consultations, or limits on reimbursement. Premiums usually range from Rs 4,000–Rs 6,000 a year for individuals and Rs 8,000–Rs 15,000 for families. In many cases, these costs are recovered after just a handful of consultations or tests.

For the middle class, financial planning traditionally rested on education, housing, and retirement. But with healthcare inflation rising faster than incomes, OPD coverage plan is emerging as the fourth pillar. Hospitalisation cover prepares for emergencies, while OPD coverage supports everyday wellness. Together, they provide a complete health safety net.