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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

Liver Enzymes Test Explained – What SGPT/SGOT Mean

The liver is one of the most important organs in your body. It performs hundreds of functions, including filtering toxins, producing bile, and supporting digestion and metabolism. When your liver is under stress or not functioning properly, certain enzymes in your blood can increase. Two of the most common enzymes tested are SGPT (ALT) and SGOT (AST). In this blog, we will break down what these enzymes mean, why your doctor might suggest this test, and what the results indicate.

What is a Liver Enzymes Test?

A liver enzymes test is a type of blood test used to evaluate the health of your liver. It measures specific proteins (called enzymes) that the liver releases into your blood. When liver cells are damaged, these enzymes leak into your bloodstream. The most commonly tested liver enzymes are:

SGPT (ALT) – Serum Glutamic Pyruvic Transaminase
SGOT (AST) – Serum Glutamic Oxaloacetic Transaminase

Why Do Doctors Recommend a Liver Enzymes Test?

Your doctor may ask for a liver enzymes test if you show symptoms of liver problems or are at risk due to lifestyle or existing health conditions. Some common reasons include:

Fatigue or weakness
Yellowing of skin or eyes (jaundice)
Abdominal pain or swelling
Dark urine or pale stools
Alcohol consumption
Hepatitis (A, B, or C)
Obesity or fatty liver
Long-term medication usage
Diabetes or high cholesterol

What is SGPT (ALT)?

SGPT, also known as ALT (Alanine Aminotransferase), is an enzyme mainly found in the liver. It plays a role in converting proteins into energy for liver cells. When liver cells are damaged or inflamed, SGPT leaks into the bloodstream.

Normal SGPT Levels:

For men: 7 to 56 units per liter of blood
For women: 7 to 45 units per liter

What Does High SGPT Mean?

High SGPT levels may indicate:

Liver inflammation (Hepatitis)
Fatty liver disease
Alcohol-related liver damage
Liver infection or injury
Side effects of medications
Obesity-related liver stress

Sometimes, even intense physical activity or certain supplements can temporarily raise SGPT levels.

What is SGOT (AST)?

SGOT, also known as AST (Aspartate Aminotransferase), is an enzyme found not just in the liver, but also in the heart, kidneys, muscles, and brain. So, while it can point to liver damage, it may also indicate problems in other organs.

Normal SGOT Levels:

For men: 8 to 48 units per liter of blood
For women: 8 to 43 units per liter

What Does High SGOT Mean?

High SGOT levels may be due to:

Liver damage or cirrhosis
Heart disease or recent heart attack
Muscle injuries
Pancreatitis
Alcohol abuse
Use of certain drugs or supplements

If both SGPT and SGOT are elevated, it’s more likely to be a liver-related issue.

SGPT vs SGOT – What's the Difference?

Feature	SGPT (ALT)	SGOT (AST)
Location	Mainly in the liver	Liver, heart, kidneys, muscles, brain
Specificity	More liver-specific	Less liver-specific
Indicates	Liver damage	Liver, heart, or muscle damage
Normal Range	7–56 U/L	8–48 U/L

Conclusion: If only SGPT is high, it's more likely to be liver-specific. If both are high, the doctor may run further tests.

Other Liver Tests Often Done Together

To get a full picture of liver health, doctors may also recommend:

ALP (Alkaline Phosphatase) – Linked to bile ducts
GGT (Gamma-Glutamyl Transferase) – Linked to alcohol use or bile problems
Bilirubin – Indicates liver’s ability to process waste
Albumin and Total Protein – Reflects liver's protein production
PT/INR – Measures blood clotting, another liver function

What to Do if SGPT/SGOT Are High?

If your test results show high liver enzymes, don’t panic. A one-time elevation doesn’t always mean serious disease. Here's what you should do:

1. Follow-Up Testing

Your doctor may repeat the test after a few weeks or recommend imaging (ultrasound/CT scan) to check for liver fat, fibrosis, or tumors.

2. Lifestyle Changes

Avoid alcohol completely
Maintain a healthy diet (low-fat, high-fiber)
Exercise regularly
Control blood sugar and cholesterol
Stay hydrated

3. Review Medications

Some over-the-counter drugs like paracetamol, or supplements like bodybuilding products, can raise liver enzymes.

4. Monitor Regularly

If you have a chronic condition like diabetes, high cholesterol, or obesity, make liver function tests part of your routine health checks.

When to See a Doctor Immediately

Yellow eyes or skin (jaundice)
Severe abdominal pain
Swelling in legs or abdomen
Confusion or mood changes
Dark-colored urine or light-colored stools

These signs may indicate serious liver issues and need immediate attention.

Final Thoughts

The liver is a silent warrior – it works 24/7 and rarely complains until it's seriously damaged. That’s why regular check-ups, especially liver enzyme tests, are essential for early detection and prevention.

Understanding your SGPT and SGOT levels can give you valuable insights into your liver’s health. Whether you’re dealing with symptoms, managing a chronic condition, or just doing a preventive health check, this simple blood test can help you stay one step ahead.

Call to Action

Worried about your liver health? Book a full liver function test online today and get your results from the comfort of your home. Know your SGPT and SGOT levels now – because your health can’t wait.

Liver Enzymes Test Explained – What SGPT/SGOT Mean – Book Now on SecondMedic.com!