• 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.

Read Blog
Foods to Avoid During Rainy Season

Foods to Avoid During Rainy Season in India: Stay Safe and Healthy!

The rainy season brings a welcome relief from the scorching summer heat. The smell of wet soil, cool breeze, and refreshing showers make it a favorite season for many. However, monsoons also increase the risk of infections, especially waterborne and foodborne illnesses. That’s why what you eat during the rainy season plays a huge role in keeping you healthy.

In this blog, we’ll talk about foods to avoid during rainy season in India to protect your stomach and boost your immunity. Whether you enjoy street food or homemade delicacies, knowing what to skip is essential for a safe and sickness-free monsoon.

 

Why You Need to Be Careful About Food During Monsoon

The rainy season creates a moist environment, which is perfect for the growth of bacteria and fungi. Roads are often flooded, drains are clogged, and food hygiene can easily be compromised. The digestive system also becomes weak during this time, so heavy or contaminated food can lead to infections, stomach upset, food poisoning, diarrhea, and more.

So, let’s look at the foods that you should stay away from during the monsoon.

 

1. Leafy Vegetables

While leafy greens like spinach, cabbage, and lettuce are normally very healthy, they are not the best choice during the rainy season. These vegetables are often grown in muddy soil and can carry a lot of dirt and germs. Washing them properly becomes difficult, and consuming them raw or undercooked may cause stomach infections.

Tip: If you must eat leafy greens, cook them well and avoid raw salads.

 

2. Fried Street Food

Who doesn’t crave hot samosas, pakoras, or kachoris with chai on a rainy day? But street food is one of the main culprits behind monsoon sickness. The oil used is often reused multiple times, making it toxic. The preparation area may not be hygienic, and food is exposed to open air, flies, and moisture, leading to contamination.

Tip: Make your favorite fried snacks at home using fresh oil and clean ingredients.

 

3. Raw Sprouts

Sprouts are packed with nutrients, but they are not safe during the monsoon. The humid weather encourages bacterial growth, especially salmonella and E. coli, in raw sprouts. They can easily lead to food poisoning or stomach infections.

Tip: Lightly steam sprouts before eating, or skip them altogether during this season.

 

4. Seafood

Monsoon is breeding season for fish and other seafood. This means there’s a higher risk of consuming contaminated or stale seafood. Improper storage or transportation during the humid months makes things worse. Eating such seafood can lead to stomach infections and even serious food poisoning.

Tip: Avoid seafood during the rainy season, and switch to fresh vegetarian or poultry options instead.

 

5. Pre-Cut Fruits and Juices from Outside

It’s common to find vendors selling sliced fruits or fresh juices on the roadside. But consuming pre-cut fruits or open juices during monsoon is a big no-no. These are exposed to air and flies, and often cut with unclean knives or on dirty surfaces.

Tip: Always wash fruits at home and cut them fresh. Drink homemade juices only.

 

6. Dairy Products That Spoil Easily

Products like paneer, cream, or curd spoil quickly in humid weather. If not stored properly, they can go bad without showing any obvious signs and lead to food poisoning or stomach discomfort.

Tip: Consume dairy items fresh and avoid buying in bulk during the monsoon.

 

7. Fermented Foods

Idli, dosa batter, and other fermented items may not ferment properly due to excessive moisture in the air. Improper fermentation can lead to the growth of harmful bacteria and result in acidity, bloating, or even diarrhea.

Tip: Prepare small portions and consume them immediately. Avoid keeping batter for long hours.

 

8. Carbonated Drinks and Ice

Cold drinks and soda may feel refreshing, but they can weaken digestion. Also, ice cubes used in beverages (especially from roadside stalls) are often made from contaminated water, leading to infections like typhoid or hepatitis A.

Tip: Stick to warm water, herbal teas, or freshly boiled and cooled water to stay hydrated.

 

9. Mushrooms

Mushrooms grow in damp, dark environments and are prone to bacterial or fungal contamination. During the rainy season, the chances of toxic or wild mushrooms entering the supply chain increase.

Tip: If you love mushrooms, make sure to buy them from a trusted source and cook them thoroughly.

 

Bonus: What to Eat Instead?

To stay safe and healthy during the monsoon, focus on these safer alternatives:

  • Steamed and cooked vegetables

  • Seasonal fruits like apples, pears, and pomegranates

  • Light soups and broths

  • Boiled water

  • Home-cooked meals with minimal oil

  • Herbs like tulsi, ginger, and turmeric to boost immunity
     

 

Monsoon Health Tips

Here are a few extra tips to maintain good health during the rainy season:

  • Wash fruits and vegetables with salt or vinegar water.

  • Dry grains and pulses before storing to avoid fungal growth.

  • Use spices like pepper, asafoetida (hing), and ajwain to improve digestion.

  • Keep your kitchen and storage areas dry to prevent mold.
     

 

Conclusion

The rainy season is beautiful but also brings health challenges. By knowing what to avoid, you can enjoy the monsoon without worrying about falling sick. Hygiene, clean cooking, and smart food choices are your best friends during this season.

Remember, prevention is better than cure—especially when it comes to your diet. So, if you want to enjoy the rains without health worries, make sure to follow this guide on foods to avoid during rainy season in India.

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