Ask Wallet-wise | I fall sick every monsoon. Is there a health cover for frequent doctor visits?

Health Insurance

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Q: I am a working professional who rarely gets hospitalised, but I visit doctors at least 4 to 5 times during the rainy season. Is there an insurance plan that covers doctor consultations and lab test bills?

Expert Advice: In the fast-paced life of a working professional, health often takes a backseat until something goes wrong. But balancing work and health should go hand in hand so that you can stay on top of both your personal and professional responsibilities. During the rainy season, high humidity and stagnant water create an environment conducive to the growth of germs, making illnesses more common. While hospitalisation may be rare in your case, frequent doctor visits during the monsoon—due to colds, viral fevers, infections, and skin rashes—can add up quickly.

Standard health insurance policies in India mostly cover hospitalisation, typically requiring a minimum inpatient stay of 24 hours. However, these policies often exclude outpatient medical expenses, which can be frequent—especially during seasons like the monsoon. This gap can be effectively bridged by either opting for a policy with an inbuilt OPD cover or adding an Outpatient Department (OPD) rider to your existing health insurance policy.

An OPD rider significantly expands your coverage by including routine medical services. These commonly include consultations with general physicians and specialists, lab tests (like blood tests and X-rays), diagnostic imaging, and minor procedures that don’t require hospitalisation. Many OPD riders also cover physiotherapy sessions, which are particularly helpful during the monsoon when joint and muscle pains are common.

Another practical benefit of OPD coverage is access to teleconsultations, allowing you to speak with a doctor via phone or video call. This is especially useful during heavy rains or when you would prefer to avoid crowded clinics—offering you the convenience of medical care from home. Importantly, OPD claims usually do not affect your No Claim Bonus (NCB), so you can continue to enjoy benefits even with frequent use.

Some insurers also offer cashless OPD services, eliminating upfront payments and reducing paperwork. Preventive health check-ups, vaccination coverage, and nutritional advice may also be part of certain OPD plans, encouraging a proactive approach to health. Many policies today come with value-added benefits like wellness rewards, user-friendly apps for claims, and loyalty programs. You can even extend this coverage to your entire family with a floater plan, ensuring that everyone benefits from OPD services under a single policy.

Several insurers offer health insurance products where OPD expenses are either bundled into the base policy or are available as optional add-ons. The charges for OPD add-ons vary depending on the sum insured, age, coverage limits, and geography. For instance, the additional premium for an OPD benefit might range from Rs 1,000 to Rs 5,000 or more annually, depending on the extent of coverage offered and will vary from insurer to insurer.

Some comprehensive health plans also offer enhanced OPD benefits, such as value-based services or structured wellness programs that can offer up to twice the value of the OPD amount through a defined network of healthcare providers. These features are designed to promote preventive care, support early diagnosis, and optimise overall healthcare spending.

For those managing chronic conditions such as diabetes, hypertension, or asthma, where regular medical consultations, diagnostic tests, and long-term medication are a necessity health insurance policy with an OPD rider is a smart, cost-effective solution. It ensures your routine healthcare needs are covered without draining your savings.

Choose a health plan that matches your lifestyle and healthcare habits, so you stay protected and productive all year round.

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