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

Exploring The Importance Of OPD Coverage In Health Insurance

  • WhatsApp share link icon
  • copy & share link icon
  • twitter share link icon
  • facebook share link icon

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
Is skipping breakfast harming your metabolism

Is Skipping Breakfast Harming Your Metabolism? Here’s What You Need to Know

Introduction

We've all heard the saying: “Breakfast is the most important meal of the day.” But in our fast-paced lives, skipping breakfast has become a common habit. Whether it's due to running late, following a weight-loss plan, or simply not feeling hungry, many people routinely skip their morning meal. But have you ever stopped to think — is skipping breakfast harming your metabolism?

In this blog, we’ll explore the science behind breakfast, its impact on metabolism, and whether missing this meal can actually do more harm than good.

 

What is Metabolism?

Before we dive into the breakfast debate, let’s first understand metabolism. Metabolism refers to the chemical processes in your body that convert food into energy. This energy fuels every function in your body — from breathing and digesting to moving and thinking.

A healthy metabolism is essential for:

  • Maintaining a healthy weight

  • Proper digestion

  • Regulating body temperature

  • Hormonal balance

  • Cellular repair
     

Your metabolic rate — how fast your body burns calories — can be affected by age, genetics, physical activity, and diet.

 

The Role of Breakfast in Metabolism

Breakfast literally means "breaking the fast." After a night of sleep, your body has gone hours without food. Eating in the morning gives your metabolism a kickstart. It signals your body that it's time to get moving, burning calories and using energy.

Here’s how breakfast helps your metabolism:

  • Boosts metabolic activity early in the day.

  • Helps regulate blood sugar levels.

  • Reduces the likelihood of overeating later.

  • Supports muscle mass and overall energy levels.

  • Helps in maintaining a healthy weight over time.
     

 

Skipping Breakfast: Common Reasons

People skip breakfast for several reasons:

  • Time constraints during busy mornings

  • Lack of appetite in the morning

  • Belief that skipping breakfast leads to weight loss

  • Following intermittent fasting diets
     

While skipping a meal occasionally isn’t dangerous, making it a regular habit can have long-term effects on your health and metabolism.

 

What Happens When You Skip Breakfast?

Now let’s get to the heart of the matter — is skipping breakfast harming your metabolism?

Here's what science and experts suggest:

1. Slower Metabolism

When you skip breakfast, your body stays in "fasting mode" for longer. This may slow down your metabolism as the body tries to conserve energy.

2. Increased Cravings & Overeating

People who skip breakfast often report stronger hunger pangs later in the day. This can lead to overeating during lunch or snacking on unhealthy foods — both of which can negatively impact your metabolism.

3. Insulin Resistance

Skipping breakfast regularly may cause insulin resistance, making it harder for your body to process sugar. This increases the risk of type 2 diabetes and obesity, both of which are linked to a sluggish metabolism.

4. Poor Energy & Concentration

A lack of morning fuel can make you feel sluggish, tired, and unfocused. Low energy levels can lead to reduced physical activity, which also slows down metabolism.

5. Disrupted Hormonal Balance

Your hormones — especially those that control hunger and metabolism like cortisol, ghrelin, and insulin — get affected when you skip meals. This imbalance may reduce your body's metabolic efficiency.

 

What Do Studies Say?

Research offers mixed results. Some studies show that skipping breakfast is associated with weight gain and metabolic issues, while others say it depends on the person’s overall diet and lifestyle.

However, most nutritionists agree: a balanced breakfast supports metabolic health and can help in managing weight more effectively.

 

Healthy Breakfast Ideas to Boost Your Metabolism

If you’re convinced to bring back breakfast into your routine, here are a few healthy and metabolism-friendly options:

  • Oats with nuts and fruits

  • Greek yogurt with berries

  • Boiled eggs and whole grain toast

  • Smoothie with spinach, banana, and protein powder

  • Upma or poha with vegetables

  • Dalia or khichdi with ghee
     

These meals are rich in protein, fiber, and healthy fats — all of which keep you full and help your body burn calories more efficiently.

 

Tips to Never Skip Breakfast Again

  • Plan Ahead: Prep your breakfast the night before.
     

  • Keep It Simple: A banana and peanut butter toast is better than nothing.
     

  • Set an Alarm: Wake up 10 minutes early to make time for a quick meal.
     

  • Stay Hydrated: Sometimes, drinking water first thing in the morning can stimulate appetite.
     

  • Listen to Your Body: Eat when you're hungry, but don’t wait too long after waking up.
     

 

Conclusion

Skipping breakfast may seem like a harmless or even helpful habit, especially for those trying to lose weight or save time. However, over time, this can lead to reduced energy, poor concentration, increased cravings, and — most importantly — a sluggish metabolism.

So if you’re still asking yourself, "Is skipping breakfast harming your metabolism?", the answer is: very likely, yes.

Make time for a nutritious breakfast and give your body the healthy start it deserves. Your metabolism will thank you!

 

CTA:
Start your day right and give your body the fuel it needs — because “Is skipping breakfast harming your metabolism?” isn’t just a question; it’s a health wake-up call. Don’t skip it. Fix it!

See all

Live Doctor consultation
Live Doctor Chat

Download Our App & Get Consultation from anywhere.

App Download
call icon for mobile number calling and whatsapp at secondmedic