Ever wondered why some medical bills hit harder than others? That’s because hospital treatments fall into two different categories: inpatient department (IPD) and outpatient department (OPD). So, which one would you choose for your health insurance? The one that saves you from burning your savings for routine visits or the other that protects you during a medical emergency? 

At Ditto, we simplify health insurance so you can make confident, informed decisions. Through this guide, we will help you understand how IPD and OPD coverage types actually work, the key differences between the two, and what is covered under them. 

Pro tip: The health insurance market can be a labyrinth. Instead of spending hours navigating through the hundreds of policies out there, why not book a free call with our expert IRDAI-certified advisors? We don’t spam or pressure you to buy. Just honest insurance advice.

What Is the Difference Between IPD and OPD in Health Insurance?

Inpatient hospitalizations cover hospital admissions, such as surgeries or serious illnesses. In short, anything that requires a person to be hospitalized for at least 24 hours falls under IPD. This is typically the primary component of any health insurance plan.

To understand, let’s take the example of Ravi, a 32-year-old marketing professional. 

He recently took a health insurance plan for the first time. A few months later, Ravi caught a bad case of appendicitis and had to undergo surgery. Thankfully, there were no out-of-pocket costs as his insurance covered the hospital stay, surgery, and recovery. That’s because it falls under IPD.

Now, let’s take another case. 

A few weeks later, Ravi visited a dermatologist for a skin allergy and underwent some blood tests. This time, he was surprised to learn that not everything was covered in his policy. Why? Because this was OPD, and his plan didn't include it.

OPD takes care of everyday health needs, such as doctor consultations, blood tests, or X-rays. It also covers minor procedures that don’t require admission. However, this cover is optional and may have a cap on the annual amount you can claim.

Ditto’s advisors usually recommend prioritizing IPD coverage, since hospitalization costs can financially drain you far more than routine doctor visits. OPD is also useful, but only if you frequently visit specialists or have recurring outpatient expenses.

Let’s compare a few more differences between IPD and OPD:

IPD vs OPD: Key Differences You Should Know

Category IPD Insurance OPD Insurance
Coverage Type Covers inpatient hospitalization expenses like room charges, surgeries, and daycare treatments. Covers outpatient medical expenses like doctor consultations, diagnostics, and medications.
Types of Expenses Covered Hospitalization expenses
Surgical costs
Medications (part of hospitalization)
Diagnostic tests
Pre and Post-hospitalization expenses
Doctor's consultation fees
Diagnostic tests
Medications
Dental and vision care
Preventive care
Claim Process Cashless and reimbursement Reimbursement primarily (sometimes cashless)
Examples Cataract, knee replacement surgery Regular checkup and dental checkup
Coverage Limitations Coverage limits vary based on the sum insured, room rent restriction, or disease-wise limits. Limits on the number of visits or the total amount reimbursed annually for each service type
Waiting Period May have a waiting period (except group health insurance) Initial waiting period based on the plan
Bottom line:

IPD covers major treatments like surgeries, hospital admissions, and critical illnesses. OPD, on the other hand, handles regular healthcare requirements, such as doctor consultations, pharmacy bills, and diagnostic tests.

If you are still unsure what's right for you, let's simplify this:

OPD supports your regular healthcare needs, but IPD keeps you safe during emergencies.

What’s Covered Under IPD Health Insurance?

There are two types of IPD hospitalizations, and your health insurance coverage can differ based on the one you choose.

1) Emergency Hospitalization

It’s a situation where the patient requires immediate medical attention. In this case, the person must inform the insurer within 24 hours of getting admitted. 

Once done, the insurer will either approve a limit up to which the patient can make a cashless claim or let them know if they need to pay the entire amount before filing a reimbursement claim.

2) Planned Hospitalization

This involves scheduled medical surgeries or procedures, such as joint replacements or planned deliveries. We also refer to it as 'elective procedure hospitalization.’ In the event of a planned hospitalization, one must notify the insurer at least 24-48 hours in advance. 

Then, the company pre-approves an amount for cashless claims or lets the policyholder know that the facility is unavailable for cashless treatments.

Based on emergency or planned hospitalizations, here are some everyday expenses covered under IPD insurance:

    • Hospitalization Costs: This includes nursing expenses, room charges, and other related costs associated with the policyholder’s hospital stay. 
    • Surgical Expenses: Expenses related to operation theater charges, surgeries, surgeon's fees, and other anesthesia costs.
    • ‍ Diagnostic Tests: Charges for X-rays, MRIs, and blood tests.
    • Pre- and Post-hospitalization Expenses: A few IPD insurance policies also cover pre- and post-hospitalization expenses for a particular period after discharge.
    • Medications: The cost of drugs or medicines prescribed during the hospital stay.
At Ditto, we always remind people that health insurance coverage varies depending on your policy. That’s why we recommend checking for inclusions and exclusions in advance to avoid unexpected out-of-pocket expenses during hospitalization.

What Does OPD Cover in a Health Insurance Policy?

An OPD health insurance policy covers: 

    • Consultation Fees: The charges for visiting a physician or specialist.
    • Diagnostic Tests: Costs associated with initial tests and screenings.
    • Medications: The expense of prescribed drugs or medications.
    • Dental and Vision Care: Coverage for eye examinations,  dental checkups, and related costs.
    • Preventive Care: Expenses for vaccinations, health checkups, and various wellness programs.

Unlike IPD, which allows both cashless and reimbursement claims, OPD expenses are usually limited to reimbursement only. Here’s how you can file an OPD claim:

    • Healthcare providers or clinics provide you with a bill for the OPD services they offered. This bill includes a breakdown of various charges for each consultation, service, or medical test.
    • You must pay the bill directly to the healthcare provider. Insurance plans may cover some or all of these OPD hospitalization costs, depending on the policy and coverage type.
    • Submit the bills and receipts to your insurance company for reimbursement. Remember that these claims are subject to the terms and conditions of your policy.
    • You must also maintain proper documentation of your OPD expenses for future reference or reimbursement. 

Did You Know: Unlike IPD, OPD benefits can be used without hospital admission, and are ideal for managing day-to-day healthcare expenses.

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Is OPD Covered in All Health Insurance Plans?

Most insurers offer it as a built-in feature or as a rider for individuals who have frequent consultations.

"Not all health insurance plans include OPD coverage by default," says Gaurav, one of our senior advisors.

At Ditto, we recommend OPD coverage for young families or individuals who regularly visit doctors, require diagnostic tests, or need to refill their medication. In short, we suggest OPD riders only for:

    • Individuals managing chronic illnesses like diabetes or PCOS.
    • Parents with young children who need frequent pediatric visits or vaccinations

Let’s take the example of Neha and Karan, a young couple in Bengaluru, who have a 4-year-old daughter who’s often down with colds, fevers, or seasonal allergies. Pediatrician visits, throat swabs, and blood tests were becoming a routine, with each clinic visit costing them anywhere between ₹800 to ₹1,200, around 8–10 times a year.

So, when their insurer introduced an OPD rider, they opted in. It cost ₹2,500 a year and covered unlimited teleconsultations, 8 in-clinic specialist visits (including pediatricians) capped at ₹500 each, and prescribed diagnostics up to ₹3,000 annually. In just one policy year, they recovered ₹6,000–₹7,000, which is more than double what they paid.

But for Neha and Karan, the biggest benefit wasn’t just the money saved. It was the peace of mind that came with knowing they could get quick pediatric advice anytime, and not hesitate to visit the doctor when needed.

This brings us to another important question:

Should You Add OPD Cover to Your Health Insurance Plan?

Yes, if your medical needs often involve regular consultations, diagnostics, or follow-ups. These out-of-pocket expenses can add up quickly if you don’t have an OPD cover.

Ditto’s Advice:

We generally do not recommend the OPD cover for everyone, as it comes with higher premiums and limited benefits. But in several cases, this cover makes sense.

According to our senior advisors, you can:

Add OPD cover if:

– You visit doctors regularly for chronic conditions

– You have dependent children or elderly parents

– You need frequent diagnostics, tests, or follow-ups

Skip OPD cover if:

– You are young and healthy, and rarely visit a doctor

– You want to keep your premiums low

– You would rather pay out-of-pocket for occasional checkups

Pro Tip: Always read the fine print to learn what’s covered (and what’s not) in IPD and OPD health insurance before choosing a plan. If you're unsure, book a free call, and we'll help you work out the details.

Things to Check Before Choosing IPD or OPD Cover

IPD or OPD coverage in health insurance may seem attractive, especially when considering the rising costs of medical care and hospitalization. We suggest analyzing whether the coverage aligns with your healthcare needs and financial expectations.

Having reviewed over 150+ health insurance plans, our advisors recommend considering these key factors before making a decision.

    • Health Needs: Your medical history and frequency of hospital visits can help you determine your IPD or OPD coverage requirements.
    • Premium Costs: As we highlighted earlier, OPD coverage may lead to an increase in your premiums. Hence, you must check whether it's cost-effective enough based on your healthcare needs.
    • Age and Family Size: Larger families or older individuals might benefit more from combined IPD and OPD coverage due to increased healthcare needs.
    • Network Hospitals: Ensure that your health insurance policy covers both IPD and OPD in a vast network of hospitals

To sum up, both IPD and OPD have their advantages. So, we recommend choosing a health insurance policy after analyzing your medical needs.

Why Approach Ditto for Your Health Insurance Plan?

At Ditto, we’ve assisted over 7,00,000 customers with choosing the right IPD or OPD health insurance policy. Here’s why customers like Ajay love us:

IPD vs OPD

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IPD vs OPD: Key Takeaways

IPD and OPD treatments are completely different, which is why you must consider several things before deciding on your insurance policy. To help you make a better decision, here are our key takeaways:

    • IPD covers hospitalization, while OPD includes consultations, diagnostics, and minor treatments that do not require admission.
    • OPD claims are usually reimbursed, while IPD claims can be either cashless or reimbursed. 
    • Not all health insurance plans cover OPD, so check coverage and whether the extra premium is worth it.

Still unsure whether IPD or OPD coverage is right for you? WhatsApp us or book a free call with a Ditto advisor to receive unbiased guidance based on your needs. We're here to help you make the smartest choice for your health insurance.

FAQS on IPD vs OPD in Health Insurance

Is daycare treatment and OPD the same?

Excellent question! Here’s how we usually explain this to our users: daycare treatment and OPD are not the same. The former usually involves a brief hospital admission for the insured, usually for 24 hours. On the contrary, OPD involves consultations and minor procedures that don't require a hospital stay.

What are the exceptions for adding an OPD cover to health insurance policies?

Ditto advisors have analyzed multiple policies to identify exceptions related to OPD coverage. What we have found is that most health insurance plans with an in-built OPD cover have a waiting period. Moreover, there may be sub-limits on the amount that you can claim for specific services. Most importantly, not all medical expenses are covered under the OPD cover.

Are medical emergencies also included under OPD?

Of course! Although the OPD is for non-emergency cases, it also handles follow-up appointments for chronic patients to ensure continuity of care. Emergency services, on the other hand, are provided for immediate medical attention.

Does adding OPD cover increase the premium of a health insurance plan?

Yes, including OPD benefits in your health insurance plan increases the premium. These expenses are more frequent and likely to be claimed, unlike hospitalization, which occurs less often.

Can I choose a health insurance plan that gives me IPD-only for now and add OPD later?

You can absolutely do that, provided your insurer allows it. IPD is the core component of health insurance, so it's covered by default in nearly all standard health plans. OPD, on the other hand, is treated differently. You may either get it as an optional add-on rider or an in-built benefit. In some cases, it may not be available with the policy at all. 

Adding OPD later may also come with certain conditions, such as waiting periods, sub-limits, or additional premiums.

 

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