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  • Glossary

    Health Insurance Terms Made Easy To Understand.

Optional Cover

An optional cover is a separate, usually minor package that enhances a standard insurance policy's coverage while offering financial protection to policyholders against certain specific and high-cost medical treatments. The insurance company generally charges a slightly higher premium for the add-on rider. Examples of add-on covers include, maternity cover, critical illness cover, hospital cash benefits, etc.

Out-Patient Department (OPD)

The Out-Patient Department (OPD) is an individual healthcare facility (e.g. a clinic) or a hospital department that offers consultation services and diagnoses and treats patients based on a medical practitioner's advice. OPD deals with medical care that does not require hospitalisation. Insurance providers typically cover OPD expenses like medical tests, routine check-ups, physiotherapy, dental treatments, doctor's fees, etc., based on a health insurance policy's terms.

OPD Treatment

A medical treatment plan which does not require a patient to be hospitalised is known as an out-patient department or OPD Treatment plan. OPD treatments typically include consultations and minor procedures completed at OPD facilities, following which the patient can complete the remaining treatment course at home. Insurance providers usually cover the costs of various OPD Treatments mentioned in the policy documents.

Out-of-pocket Expenses

Out-Of-Pocket Expenses are those costs that an insurance provider is not liable to cover per the policy terms. The policyholder must bear such costs on their own. In health insurance, deductibles and co-payments are examples of typical out-of-pocket expenses. Any amount exceeding the sum insured or the established expense limit per variable (e.g. room rent) also falls under out-of-pocket expenses.

Organ Donor Expenses

Organ Donor Expenses entail the costs associated with hospitalisation for an organ donor wherein the organ recipient is an insured person. Per IRDAI guidelines, an organ donor must comply with the Transplantation of Human Organs (Amendment) Bill, 2011, and the other relevant laws to qualify for expense coverage. Medical insurance plans may not cover pre and post-hospitalisation expenses for organ donors.