Call / Whatsapp
+918447748545

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

Exploring The Importance Of OPD Coverage In Health Insurance

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.

Read Blog

Simple Habits to Avoid High Cholesterol

High cholesterol is one of the leading causes of heart disease and stroke worldwide. In India, rising cholesterol levels are becoming more common due to sedentary lifestyles, unhealthy food habits, and stress. But the good news is—you can prevent high cholesterol naturally with a few simple habits.

In this blog, we’ll explore easy, everyday steps you can take to keep your cholesterol levels in check and protect your heart.

What Is Cholesterol?

Cholesterol is a fatty substance found in your blood. While your body needs some cholesterol to build cells and hormones, too much of the wrong type—called LDL (low-density lipoprotein)—can be harmful. It can build up in your arteries and increase your risk of heart disease and stroke.

There’s also HDL (high-density lipoprotein), which is the “good” cholesterol that helps remove LDL from your body.

Why High Cholesterol Is Dangerous

Clogs arteries and restricts blood flow
Increases risk of heart attacks and strokes
Can lead to high blood pressure
May affect kidney and liver function

The scariest part? High cholesterol usually has no symptoms. That’s why it’s called a silent killer and must be managed before problems begin.

7 Simple Habits to Avoid High Cholesterol

1. Eat Fiber-Rich Foods Daily

Soluble fiber binds with cholesterol in the gut and removes it from your body.

Best foods for fiber:

Oats and barley
Apples, pears, and oranges
Beans and lentils
Flaxseeds and chia seeds

Tip: Start your morning with a bowl of oatmeal and add a fruit—it’s a heart-healthy breakfast!

2. Stay Active Every Day

Physical activity boosts HDL (good cholesterol) and burns fat that raises LDL.

What to do:

Walk briskly for 30 minutes a day
Try yoga, cycling, or dancing
Use stairs instead of the lift
Take short walks after meals

Even small movements throughout the day matter.

3. Cut Down on Saturated & Trans Fats

These fats raise your LDL cholesterol quickly.

Avoid:

Fried food, chips, and baked snacks
Ghee-heavy sweets
Processed foods with “hydrogenated oils”

Choose instead:

Olive oil or mustard oil
Grilled or baked foods
Fresh fruits and nuts as snacks

4. Manage Your Stress

Stress affects your hormones and may raise your cholesterol over time.

Try this:

Practice deep breathing or meditation
Do relaxing hobbies like reading or gardening
Take tech breaks and sleep 7–8 hours daily
Talk to someone if you’re feeling overwhelmed

A calm mind supports a healthy heart.

5. Stay Hydrated and Cut Sugary Drinks

Water helps regulate body functions and weight, which both impact cholesterol.

Do this:

Drink 8–10 glasses of water daily
Avoid soft drinks and energy drinks
Switch to herbal teas or infused water

Too much sugar can raise triglyceride levels, a type of fat in your blood.

6. Quit Smoking and Limit Alcohol

Smoking lowers good cholesterol and damages arteries. Alcohol, in excess, can also spike cholesterol and blood pressure.

Tip:
Even reducing smoking or drinking frequency helps your heart function better.

7. Get Regular Cholesterol Tests

Don’t wait for symptoms. Get your lipid profile checked every year, especially if you have:

A family history of heart disease
Diabetes or high blood pressure
Obesity or unhealthy lifestyle habits

Suggested Test:
Lipid Profile Test by Thyrocare via SecondMedic.com – includes LDL, HDL, total cholesterol, and triglycerides with home sample collection.

Normal Cholesterol Levels:

Type	Ideal Range
Total Cholesterol	Below 200 mg/dL
LDL (Bad)	Below 100 mg/dL
HDL (Good)	Above 40 mg/dL (men), 50 mg/dL (women)
Triglycerides	Below 150 mg/dL

Tips to Book a Test via SecondMedic:

Visit www.secondmedic.com
Search for Lipid Profile Test – Thyrocare
Select home collection
Fast for 9–12 hours before the test
Get results in 24–48 hours

Bonus Tips

Replace white rice with brown rice or millets
Choose low-fat milk and curd
Snack on almonds or walnuts
Cook at home more often than eating out
Maintain a healthy weight

Conclusion

You don’t need fancy diets or harsh treatments to manage cholesterol. Just a few simple daily habits can make a big difference in protecting your heart.

By eating better, moving more, managing stress, and staying hydrated, you can keep your cholesterol in check without medication in many cases.

Make your heart health a priority starting today!

Start following these simple habits to avoid high cholesterol and keep your heart happy for years to come.

Request A Callback

+91

By using this website/app, I confirm that I am at least 18 years old and consent to the processing of my personal data in accordance with the Terms of Service, Privacy Policy, and Declaration.