Why Indian insurers are expanding plans with outpatient health benefits

Regular outpatients have 5% to 10% fewer hospitalisations.

India’s health insurance market is seeing strong growth in outpatient department (OPD) coverage, with adoption up 4.5 times in three years, according to Policybazaar. 

OPD riders were attached to just 5% of health plans in fiscal year 2023 but have climbed to 22% in FY26, making them part of one in five policies sold.

Insurers report that regular OPD users have 5% to 10% fewer hospitalisations, highlighting its preventive impact. 

OPD claims are frequent, with users filing three to four times a year compared with infrequent hospital claims. 

About 90% of OPD claims are cashless, allowing members to pay at clinics or pharmacies like using a health wallet.

Consultations account for the largest share of claims at 35% to 40%, followed by diagnostics (25% to 30%) and pharmacy expenses (20% to 25%). Teleconsultations now make up 45% to 50% of usage, nearly matching in-person visits.

Adoption is highest amongst urban professionals aged 30 to 45 (33%), followed by those 18% to 30 (27%). 

Men account for 80% of policyholders, though women’s participation is rising. 

Tier-1 cities drive half of OPD sales, with Mumbai, Hyderabad and Chennai amongst the top hotspots.

Policybazaar said rising awareness, app-based claims, and higher OPD limits—up to ~$1,134.36 (₹1 lakh)—are making coverage more attractive and meaningful for everyday healthcare needs.