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/OPD Treatment
Find what matters most to you.
Pick a coverage concern and see its exact policy terms, compared side-by-side across top Indian health insurance plans.
36 features mapped
6 coverage topics
Start here8
The concerns that cost the most when a plan gets them wrong
Step 1Coverage Directory
Every category, decoded
All 6 coverage topics in one place - start with the worry on your mind, and open the features that decide it.
Step 2Feature Library
Everyday medical costs
Every feature behind Everyday medical costs, deciders first - pick one to see how the plans differ.
2 more features here look much the same across the plans we cover - they rarely decide the choice.
Step 3Plan Comparison
What is OPD Treatment in health insurance?
Covers everyday healthcare costs that do not require a hospital stay - like visiting a specialist, getting a blood test, or buying prescription medicines. Most health plans only cover you when you are admitted to hospital. OPD cover means your insurance is useful throughout the year, not just in emergencies.
Also called: Out-Patient Department (OPD) cover · outpatient treatment · doctor consultation cover
Every plan, ranked11 · 3 standard · 4 limited · 4 not covered
Aditya BirlaStandardActiv One · VYTLIncluded in the base plan
Standard
There is no general OPD cover here - an ordinary doctor visit, test or medicine bill outside hospital is not paid. The only OPD benefit is the Chronic Management Program: a fixed number of teleconsultations and diagnostic tests for chronic conditions you have declared, such as diabetes or asthma, cashless at network providers. Most plans sell it as a paid option, VYTL includes it, and VIP and VIP+ do not offer it at all.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
GP consultationsCovered - up to 2/year
Diagnostic Tests CoveredYes
Medicines / Pharmacy CoveredNo
Specialist Consultations Covered (Beyond GP)Yes
Niva BupaStandardReAssure 3.0 · ClassicOptional - 1×, 2×, 3×, 4×, 5× of base premium
Standard
Out-patient cover comes only from the optional WellConsult+ benefit. You choose a WellConsult+ Sum Insured of 1x to 5x your base premium, and that pool pays for consultations, prescribed diagnostics, pharmacy, dental, eye and physiotherapy visits. Each head has its own share of the pool - in-clinic consultations 37.5%, diagnostics 20%, medicines 5%. Tele-consultations are unlimited.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
OPD limit1×, 2×, 3×, 4×, 5× of base premium
GP consultationsCovered - with no cap
Diagnostic Tests CoveredYes
Medicines / Pharmacy CoveredYes
Watch out
WellConsult+ works in India only. If you pay the clinic yourself and claim the money back, a flat 20% co-payment applies - on a ₹10,000 OPD bill you pay ₹2,000 from your own pocket. Cashless within the partner network avoids this.
ICICI LombardStandardElevateOptional - ₹7,500 per year
Standard
Out-patient care is excluded from Elevate unless you buy the BeFit Optional Cover. BeFit pays doctor consultations, prescribed tests and prescribed medicines, but only cashless through the insurer's app and network. What you get depends on the BeFit plan: the largest gives 12 consultations plus ₹7,500 for tests and ₹7,500 for medicines a year, the smallest one consultation and ₹500 each.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
OPD limit₹7,500 per year
GP consultationsCovered - up to 12/year
Diagnostic Tests CoveredYes
Medicines / Pharmacy CoveredYes
Watch out
BeFit starts 30 days after you buy it, and nothing unused carries to the next year. Dental treatment, genetic studies, supplements, vitamins and vaccinations stay outside it. You can only add BeFit up to age 65, at first purchase.
Star HealthLimitedStar Comprehensive₹2,100 per year
Limited
Out-patient doctor consultations at a Star Health network facility are paid from outside your Sum Insured, up to a yearly limit set by your Sum Insured - Rs.1,200 at Rs.5,00,000, rising to Rs.5,000 at Rs.50,00,000 and above. Each single consultation is capped at Rs.300, so the yearly limit buys four to sixteen visits. Tests and medicines are not covered.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
OPD limit₹2,100 per year
GP consultationsCovered - ₹300 each
Diagnostic Tests CoveredNo
Medicines / Pharmacy CoveredNo
Watch out
Dental and eye consultations are not paid here; they come under a separate three-year limit. See a doctor outside the Star Health network and this benefit pays you nothing. Available on a cashless basis only.
Star HealthLimitedSuper StarOptional - ₹25,000 per year
Limited
There is no out-patient cover for consultations, medicines or ordinary tests. The one thing paid without an admission is the optional High-end Diagnostics cover: nine named scans and biopsies, among them PET CT, PET MRI and Liver Biopsy, payable on an OPD basis up to Rs.25,000 in a Policy Year when the test is part of a treatment.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
OPD limit₹25,000 per year
GP consultationsNot covered - up to 0/year
Diagnostic Tests CoveredYes
Medicines / Pharmacy CoveredNo
Watch out
High-end Diagnostics can only be added in the first three policy years, and medical underwriting applies where a pre-existing disease is declared. Only the 30-day initial waiting period applies to it.
HDFC ERGOLimitedOptima RestoreOptional add-on
Limited
The base plan pays nothing for outpatient care. Anything that could have been treated without a hospital admission is excluded, so doctor visits, tests and medicines on their own are not payable. Outpatient cover exists only if you buy the Optima Wellbeing add-on, which both documents name in a single line and describe no further.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Add-on NameOptima Wellbeing
Watch out
Neither the policy nor the prospectus gives the add-on's limit, the number of consultations, or what it pays for. Ask for the Optima Wellbeing wording and its premium before you count on outpatient cover.
HDFC ERGOLimitedOptima SecureOptional add-on
Limited
The base policy pays nothing for treatment taken as an outpatient - doctor visits, tests and medicines outside a hospital stay are excluded on every plan. OPD is available only if you buy the separate Optima Wellbeing add-on, whose limits and terms are set out in that add-on's own documents, not in this policy.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Add-on NameOptima Wellbeing
Watch out
Ask for the Optima Wellbeing schedule before you buy: the amount you get, the co-payment and what counts as an outpatient expense are all decided there, not here.
Star HealthNot coveredFamily Health OptimaNot in this plan, and not sold as an add-on
Not covered
This plan pays only when you are admitted to hospital. Doctor visits, tests and medicines you buy without being admitted are not covered.
Coverage detailstap any row to understand it
How it's coveredNot covered
Care HealthNot coveredCare AdvantageNot in this plan, and not sold as an add-on
Not covered
Care Advantage does not cover out-patient treatment. Doctor visits, tests and medicines taken without being admitted are not paid by this policy.
Coverage detailstap any row to understand it
How it's coveredNot covered
Care HealthNot coveredCare SupremeNot in this plan, and not sold as an add-on
Not covered
Care Supreme does not cover out-patient treatment. Doctor visits, tests and medicines taken without being admitted are not paid by this policy. What the plan gives you instead is Discount Connect - cheaper rates at the insurer's network for OPD, diagnostics and pharmacy - so you still pay those bills yourself, only at a lower price.
Coverage detailstap any row to understand it
How it's coveredNot covered
Watch out
Two optional benefits do pay some out-patient bills, but both are narrow: Women Care covers three diagnostic tests for women aged 18 and above, and Mental Health wellbeing covers consultation and counselling for four listed conditions. Neither pays for general consultations, routine tests or medicines.
Star HealthNot coveredStar Health AssureNot in this plan, and not sold as an add-on
Not covered
Star Health Assure has no out-patient benefit. Doctor visits, tests and medicines taken without being admitted are not paid. Out-patient expenses appear in only two named covers - treatment of Chronic Severe Refractory Asthma by Advanced Medicine, and rehabilitation after an admissible in-patient claim - and both are scored under their own features, not as OPD cover.
Coverage detailstap any row to understand it
How it's coveredNot covered
Watch out
If you want everyday doctor, pharmacy and diagnostic cover, this policy will not give it to you. Plan for those costs separately.
Step 4Shortlist
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Or read one we prepared for OPD TreatmentSuper Star vs Optima RestoreSuper Star vs Star ComprehensiveOptima Restore vs Star Comprehensive
Every feature, A to Z
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