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Are OPD charges covered under health insurance?

Q: Could you please tell me whether dental treatment is covered under mediclaim policy or not? Recently, I came across an article which said that the supreme court has passed a resolution regarding the coverage of OPD charges under medical insurance. Can you give me some infornation on this? I have a mediclaim card by IFFCO.

A:The OPD cover in health insurance is not provided for retail policies but may be provided in group policies viz. corporate insurance covers but that happens when the corporate specifically demands for that cover and then based on the underwriting guidelines of the insurance company, they may, after loading the premium appropriately, provide that cover. A Point to note here is that the terms of a regular health insurance cover does not automatically provide for coverage of Dental Treatment and even if dental treatment is covered by the insurance company, cosmetic dental treatment will still be excluded. The Supreme court ruling that you have mentioned, would be in a different context since the insurance cover is a contract for specific coverage and despite the Honourable Courts ruling, it does not include coverage for all ailments. Though there are certain procedures done as OPD which do get covered but those are specifically where technology has advanced to the degree that it no longer requires hospitalisation for treatment viz Cataract, Dialysis etc.


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