• Published on: Jul 17, 2023
  • 2 minute read
  • By: Secondmedic Expert

Exploring The Importance Of OPD Coverage In Health Insurance

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In the realm of medical expenses, outpatient costs usually pale in comparison to inpatient expenses. However, a recent study conducted by ET Prime sheds light on a surprising revelation - outpatient department (OPD) expenses account for approximately 62% of healthcare costs in India. As healthcare expenses continue to soar, it becomes crucial to consider health insurance plans that include comprehensive OPD coverage. This article aims to provide readers with a thorough understanding of OPD coverage in health insurance and the associated benefits.

Understanding OPD Coverage in Health Insurance

OPD coverage within health insurance pertains to situations where individuals require medical attention without the need for hospitalization. This coverage acts as a financial safeguard, protecting policyholders from the financial burdens associated with OPD-related treatments and consultations. OPD treatments can be received by visiting a doctor's clinic and paying the consultation fees. Alternatively, hospitals may provide support and medical assistance through their general OPD ward.

Virtually all health insurance companies offer a variety of plans that incorporate OPD treatments. OPD coverage is designed to cater to expenses that are not covered during inpatient hospitalization.

Advantages of OPD Coverage in Health Insurance Plans

Let us delve into the advantages associated with having OPD coverage within health insurance plans:

1. Claiming Medical Expenses: OPD coverage allows individuals to claim medical expenses incurred without the need for hospitalization, thus providing much-needed financial relief.

2. Coverage for Diagnostic Charges, Consultation Fees, and Pharmacy Bills: Comprehensive OPD coverage encompasses diagnostic charges, doctor's consultation fees, and pharmacy bills, ensuring individuals receive holistic medical support.

3. Essential for Regular OPD Visits: For those who require frequent OPD visits due to ongoing medical conditions, OPD coverage becomes indispensable for effectively managing associated expenses.

4. Tax Savings: OPD coverage can contribute to tax savings, providing an additional financial advantage for policyholders.

Eligibility Criteria for OPD Coverage

Eligibility criteria for OPD coverage are not universally defined but depend on the specific health insurance plan an individual purchases. If a health insurance plan includes OPD expenses, the policyholder can avail themselves of all the associated benefits.Inclusions of

OPD Cover in Health Insurance

  • OPD coverage typically encompasses the following aspects within health insurance plans:
  • Doctor consultations
  • OPD treatments
  • Dental treatments
  • Vaccinations
  • Pharmacy expenses
  • Diagnostic tests

Exclusions Under OPD Cover in Health Insurance

While OPD coverage provides comprehensive benefits, it is important to be aware of exclusions. The following items are generally excluded from OPD coverage in health insurance:

  • Treatments related to purification, beautification, panchakarma, detoxification, etc.
  • Expenses for lenses, spectacles, hearing aids, implants, prosthetic devices, braces, etc.
  • Treatment received outside the country.
  • Preventive health check-ups.
  • Investigational experiments.
  • Investigational treatments.
  • Infertility and sterility-related conditions.
  • Complications arising from pregnancy, miscarriage, etc.

OPD Treatment vs. Daycare Treatment

Although OPD treatment and daycare treatment share similarities, there are important technical distinctions between the two:

  • Daycare Treatment:
  • Requires hospitalization for less than one day.• Settlement of claims is honored only for hospitalizations lasting up to 24 hours.
  • OPD Treatment:
  • Does not require hospitalization.
  • Settlement of claims is honored even without hospitalization.

Outpatient Treatment vs. Inpatient Treatment

Outpatient treatments and inpatient treatments differ significantly from each other. Let us explore the differences between OPD and IPD treatments:

Outpatient Treatment:

  • No hospital admission required.
  • Does not necessitate hospitalization.
  • Inpatient Treatment:
  • Requires hospitalization for more than one day.

  • Individuals must be admitted to the hospital for the duration of the treatment.

Reasons to Consider Health Insurance Plans with OPD Coverage

Obtaining a health insurance plan with OPD coverage offers numerous advantages. Considering the increasing trend of consultations and OPD treatments, the following individuals should contemplate purchasing health insurance plans that include OPD coverage:

• Individuals aged between 25 to 40 years.

• Senior citizens.

• Retired individuals.

• Fitness enthusiasts.

By comprehending the significance of OPD coverage within health insurance plans, individuals can make informed decisions about their healthcare needs, ensuring both medical support and financial security.

Read FAQs


A. OPD coverage in health insurance refers to the inclusion of benefits for outpatient department visits, medical expenses, diagnostic tests, doctor consultations, and pharmacy bills.

A. OPD coverage provides financial protection for medical expenses incurred without hospitalization, including consultation fees, diagnostic charges, and pharmacy bills. It helps manage healthcare costs effectively and offers tax savings in some cases.

A. OPD coverage usually includes doctor consultations, OPD treatments, dental treatments, vaccinations, pharmacy expenses, and diagnostic tests within the health insurance plan.

A. Exclusions under OPD coverage may vary, but common exclusions include treatments related to purification, beautification, investigational experiments, infertility and sterility-related conditions, and complications arising from pregnancy or miscarriage.

A. OPD treatment does not require hospitalization and claims can be settled without hospitalization. Daycare treatment requires hospitalization for less than one day, while inpatient treatment requires hospitalization for more than one day.

A. Individuals aged between 25 to 40 years, senior citizens, retired individuals, and fitness enthusiasts should consider health insurance plans with OPD coverage to effectively manage their healthcare expenses and ensure financial security.

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Health

20% Health Time | A Smarter Way to Build Workplace Wellbeing

Modern workplaces are increasingly recognising that employee health is not separate from performance—it is foundational to it. Long work hours, constant digital connectivity and rising stress levels have led to burnout, lifestyle diseases and declining engagement across industries. In this context, the concept of 20% Health Time has emerged as a forward-thinking approach to workplace wellness.

20% Health Time allows employees to dedicate a portion of their paid working hours specifically to activities that support physical, mental and preventive health. Rather than treating wellness as an after-hours responsibility, this model integrates health directly into the work culture.

 

What Is 20% Health Time?

20% Health Time is a structured workplace initiative where employees are encouraged or allowed to spend approximately one-fifth of their working time on health-related activities.

These activities may include:

  • physical exercise or movement breaks
     

  • mental wellness practices
     

  • health education sessions
     

  • preventive health screenings
     

  • stress management and recovery
     

The core idea is simple: healthier employees perform better and sustain productivity longer.

 

Why Traditional Wellness Programs Fall Short

Many organisations offer wellness benefits such as gym memberships or annual checkups. While valuable, these programs often fail because:

  • employees lack time to use them
     

  • wellness is seen as optional
     

  • participation remains low
     

  • benefits are disconnected from daily work
     

20% Health Time addresses these gaps by embedding wellness into regular work hours.

 

Why Health Time Matters in Today’s Workplace

Rising Lifestyle Disease Burden

Public health data shows increasing rates of:

  • diabetes
     

  • hypertension
     

  • obesity
     

  • mental health disorders
     

These conditions affect working-age adults and directly impact productivity and healthcare costs.

 

Burnout and Mental Fatigue

Constant pressure and lack of recovery time lead to:

  • chronic stress
     

  • disengagement
     

  • absenteeism
     

  • high attrition
     

Health Time creates space for recovery and resilience.

 

Sedentary Work Culture

Desk-bound work contributes to:

  • musculoskeletal problems
     

  • cardiovascular risk
     

  • low energy levels
     

Dedicated health time encourages movement and prevention.

 

How 20% Health Time Benefits Employees

Improved Physical Health

Regular movement and preventive care reduce long-term health risks.

 

Better Mental Wellbeing

Time for mindfulness, rest and stress management improves emotional balance.

 

Higher Energy and Focus

Healthy routines improve concentration and reduce fatigue.

 

Empowerment and Autonomy

Employees feel trusted to manage their wellbeing, increasing engagement.

 

How Employers Benefit from 20% Health Time

Increased Productivity

Healthy employees work more efficiently and make fewer errors.

Reduced Absenteeism

Preventive care lowers sick days and health-related disruptions.

 

Lower Healthcare Costs

Early detection and healthier habits reduce long-term medical expenses.

 

Stronger Employer Brand

Wellbeing-focused policies attract and retain top talent.

 

Sustainable Performance

Health Time supports long-term performance rather than short-term output.

 

Activities That Fit into 20% Health Time

Organisations can tailor activities based on workforce needs:

  • guided fitness or yoga sessions
     

  • walking or movement breaks
     

  • mental health workshops
     

  • preventive health checkups
     

  • nutrition education
     

  • stress and sleep management programs
     

Flexibility ensures inclusivity across roles and work models.

 

Evidence Supporting Health Time Initiatives

Workplace health research consistently shows that:

  • preventive health improves productivity
     

  • employee wellbeing programs reduce burnout
     

  • time invested in health yields measurable returns
     

According to WHO and workplace wellness studies, integrated health initiatives deliver better outcomes than standalone benefits.

 

Addressing Common Concerns

“Will this reduce working hours?”

No. Health Time improves efficiency, offsetting time spent through better performance.

 

“Is it suitable for high-pressure roles?”

Yes. High-stress roles benefit the most from structured recovery time.

 

“How do we measure impact?”

Metrics may include:

  • reduced absenteeism
     

  • improved engagement scores
     

  • lower healthcare claims
     

  • better retention
     

 

Implementing 20% Health Time Effectively

Successful implementation requires:

  • leadership support
     

  • clear guidelines
     

  • flexible scheduling
     

  • inclusive activity options
     

  • regular feedback
     

Health Time works best when seen as a cultural shift, not a perk.

 

Long-Term Impact on Organisational Health

Over time, organisations adopting Health Time observe:

  • healthier workforce
     

  • improved morale
     

  • reduced burnout
     

  • stronger team cohesion
     

  • sustainable growth
     

These benefits compound year after year.

 

Conclusion

20% Health Time represents a progressive shift in how organisations view employee wellbeing. By dedicating work time to health, companies acknowledge that productivity and wellbeing are deeply connected. Rather than reacting to burnout and illness, Health Time promotes prevention, balance and resilience. In a future where talent, performance and sustainability matter more than ever, integrating health into the workday is not a luxury—it is a strategic necessity.

 

References

  • World Health Organization (WHO) – Workplace Health Promotion Guidelines

  • Indian Council of Medical Research (ICMR) – Lifestyle Disease and Work Health Reports

  • NITI Aayog – Preventive Healthcare and Workforce Wellbeing Strateg

  •  Lancet – Workplace Wellness and Productivity Studies

  • Harvard Business Review – Employee Wellbeing and Performance Research

  • Statista – Corporate Wellness Trends and ROI Data

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