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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.

Read Blog

Does Skipping Meals Slow Your Metabolism?

Many people skip meals hoping to lose weight or save time. But what happens inside your body when you do that? One of the most common concerns is:
Does skipping meals slow your metabolism?
Let’s explore the facts, myths, and what science really says.

What Is Metabolism?

Metabolism is the process your body uses to convert the food and drinks you consume into energy. Even when you're sleeping, your body is burning calories for basic functions like breathing and circulating blood. This is called your basal metabolic rate (BMR).

The faster your metabolism, the more calories you burn—naturally.

What Happens When You Skip a Meal?

When you skip a meal, your body starts looking for alternate energy sources. First, it uses stored glucose. If that runs out, it may break down fat or even muscle.

You may feel:

Tired or sluggish
Lightheaded or irritable
Crave sugary or high-carb foods later

If this becomes a regular pattern, it can impact your overall health and metabolism.

Does Skipping Meals Actually Slow Down Metabolism?

Short answer: Yes, it can—especially if done frequently.

Here’s how:

Your body goes into conservation mode.
To protect itself, your body may burn fewer calories if it senses food is not coming regularly.
You may lose muscle.
Skipping meals, especially without enough protein, can lead to muscle loss. Muscle burns more calories than fat—even at rest.
Hormonal imbalance.
Skipping meals can increase cortisol (the stress hormone), which is linked to fat storage, especially around the belly.
Energy dips.
Less fuel = less energy = less movement = fewer calories burned.

So yes, skipping meals may slow down your metabolism over time, making it harder to lose or maintain weight.

Is Intermittent Fasting the Same?

Not exactly. Intermittent fasting (IF) is a planned eating pattern, like eating between 12 PM and 8 PM.

It gives your body time to digest and repair, and when done right, does not necessarily slow metabolism.

The problem is randomly skipping meals without planning or nutrition tracking. That’s when metabolism can suffer.

Skipping Meals and Overeating

Another big issue is compensation. People who skip meals often overeat later in the day.

You may:

Binge on snacks
Choose unhealthy options due to cravings
Eat faster and beyond fullness

This can lead to weight gain, blood sugar spikes, and digestive discomfort.

Impact on Brain and Mood

Food fuels your brain. Skipping meals can cause:

Low focus and memory issues
Irritability and mood swings
Poor decision-making (especially with food choices)

It can also affect sleep and increase fatigue.

Healthy Alternatives to Skipping Meals

If you’re trying to lose weight or manage calories, here are smarter strategies:

1. Try time-restricted eating

Eat within a 10–12 hour window daily. This gives the benefits of fasting without shocking your system.

2. Eat smaller portions, not fewer meals

Balance your plate with carbs, protein, and healthy fats. Even 200–300 calorie meals can keep metabolism stable.

3. Stay hydrated

Sometimes thirst feels like hunger. Drink enough water throughout the day.

4. Focus on protein and fiber

They keep you full longer and help preserve muscle.

When to Worry

If you skip meals often and notice:

Constant fatigue
Weight gain despite eating less
Cold hands and feet
Hair thinning or dry skin

…these may be signs your metabolism has slowed down. Consult a doctor and consider tests like:

Thyroid function test
Vitamin B12/D3 levels
Fasting blood sugar

You can book these via SecondMedic.com, with home sample collection powered by Thyrocare.

Conclusion

Skipping meals once in a while won’t ruin your metabolism. But making it a habit can lead to slower calorie burning, muscle loss, and overeating.

If your goal is better health, focus on balanced eating, meal planning, and mindful food habits.

So, the next time you ask, “Does skipping meals slow your metabolism?”, remember—yes, it can, especially without strategy or support. Eat smart, not less.

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