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Is OPD treatment covered under health insurance?

Q: Is dental treatment covered under Mediclaim Policy / Health Insurance? I read an article that said the Supreme court has passed a law for the insurance provider to cover OPD as well. Please give me information on this.

A:The out-patient department (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. Based on the written 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 Supreme court's ruling, it does not include coverage for all ailments. Though there are certain procedures done such 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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