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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.

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Reasons Behind Low Haemoglobin in Non-Anaemic People

When people think of low haemoglobin, they often assume it's always linked with anaemia. But that’s not always true. You can have a slightly low haemoglobin count even if your red blood cell count and iron levels are still in the normal range.

So, what does it mean when non-anaemic people have low haemoglobin? Should you worry? Let’s explore the reasons behind low haemoglobin in non-anaemic people and what you can do about it.

What Is Haemoglobin?

Haemoglobin is a protein found in red blood cells that carries oxygen from your lungs to the rest of your body. The average normal levels are:

Men: 13.5 – 17.5 g/dL
Women: 12.0 – 15.5 g/dL

Levels just below the normal range may not be classified as anaemia—but they can still indicate something going on.

Common Reasons for Low Haemoglobin in Non-Anaemic People

1. Mild Nutrient Deficiencies

Even if you’re eating regularly, you could still lack key nutrients needed to build haemoglobin—such as:

Vitamin B12
Folate (Vitamin B9)
Vitamin C (helps absorb iron)

Low levels of these don’t always lead to full-blown anaemia but can reduce haemoglobin production.

2. Chronic Inflammation or Infections

Your body may produce less haemoglobin during periods of chronic inflammation—such as:

Thyroid disorders
IBS or gut issues
Low-grade infections

These may not show symptoms right away but can slightly lower your haemoglobin over time.

3. Dilution from Overhydration

If you drink too much water before a blood test, your blood plasma volume may increase and dilute your haemoglobin, giving a lower reading.

This is temporary and often not harmful, but it can confuse test results.

4. Hormonal Imbalances

Conditions like hypothyroidism can subtly affect red blood cell and haemoglobin production.

In women, heavy menstrual bleeding can cause periodic dips in haemoglobin levels—especially if not supported with iron-rich nutrition.

5. Athletic Training (Pseudo-Anaemia)

In endurance athletes or those who do high levels of cardio, the body increases plasma (fluid) volume to improve circulation. This can lower the haemoglobin concentration without reducing red cell count—this is called athlete’s pseudo-anaemia.

What Tests to Consider

If you have low haemoglobin but no signs of anaemia, your doctor may recommend:

Serum Ferritin (iron storage)
Vitamin B12 and Folate tests
Thyroid profile
CRP or ESR (for inflammation)

You can get these tests easily with home sample collection from trusted platforms like SecondMedic.com, powered by Thyrocare.

Should You Be Concerned?

If your haemoglobin is:

Slightly below normal (e.g., 11.8–12.2 g/dL)
You have no symptoms (fatigue, paleness, breathlessness)

…then it may not be an emergency. However, monitoring and lifestyle changes are still important.

If it drops further or if symptoms appear, consult a doctor immediately.

What You Can Do Naturally

Improve Your Diet

Eat leafy greens, legumes, citrus fruits
Add iron-rich foods like beetroot, dates, and jaggery
Pair iron with vitamin C (e.g., lemon + spinach)

Reduce Inflammation

Avoid excessive sugar, fried foods, and processed meals
Include turmeric, ginger, and antioxidants in your diet

Stay Active but Balanced

Don’t overtrain
Rest and hydrate well, especially before blood tests

Conclusion

Low haemoglobin without anaemia is more common than you might think. The causes are often mild and reversible, but keeping an eye on your numbers and adjusting your diet or lifestyle can make a big difference.

If you’ve been wondering about the reasons behind low haemoglobin in non-anaemic people, now you know how to understand and manage it better—naturally and confidently.

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