Is OPD covered in your health Insurance?
Most health insurance plans in India or other parts of the world do not cover OPD or other regular medical expenses. Many people think that their health insurance plans are incomplete without this.
Some insurers started covering OPD expenses as an add-on to their regular plans. But this add-on is quite expensive. If you wish to cover OPD expenses of up to Rs. 5000, you will have to pay a premium of almost the same amount. This does not make any sense.
Have you ever wondered why?
Insurance is only for unforeseen circumstances. It works on the concept of pooling of similar risks where the probability of occurrence of the insured event is small but the financial impact can be huge in case the event actually happens.
Take the case of your regular health insurance. It covers all your hospitalisation related expenses if the need arises.
Now you know that for a healthy person, the chances of getting sick and eventually taking treatment in a hospital within a year are fairly small. But in case the person does end up in a hospital, medical bills create a deep hole in his pocket.
To save yourself from such an unforeseen financial burden, you buy a health insurance plan for yourself.
The premium you pay to the insurance company includes the cost of claims, other expenses, and the profit margin for the insurer. Since you do not know in advance that such a situation will arise and if it arises, how much it will cost you, you are ready to pay this premium.
Now consider the OPD expenses. We know that OPD expenses can occur more frequently, whenever we fall mildly sick. If we are taking regular medicines for already known ailments, we already know the monthly costs associated with such treatments.
If you want your insurance company to cover such expenses, what would happen? The actual costs of such treatments taken during the year are fairly known in advance. Your insurance company will charge you for that and also add other expenses and profit margin for itself. Premiums you pay for such would not make sense.
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