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Should I Choose OPD Coverage or Health Card?

Updated On Feb 28, 2021

Health insurances have become an important part of our financial planning and daily lives and given the rising costs of medical expenses, having a health or life insurance policy has become indispensable. Regular health checkups, diagnostic tests, consultation charges, and daycare medical procedures can stir up your long-term investments and you might be left wanting an affordable solution for your health care. In this context, many people are confused about whether they should go for a health insurance policy that comes with an Out Patient Department(OPD) Coverage or a Health Card and in this article we are going to help you decide on which option is your best bet.

Characteristics of OPD Coverage

An OPD Coverage or an out-patient department coverage option that comes with a health insurance policy covers both hospitalization charges and regular checkups, diagnostic tests, and simple medical procedures that can be done by visiting a doctor’s clinic or consultation room. Let’s look at the following characteristics of OPD coverage to understand its terms better -

1. Costlier

While a standard health insurance policy would cost an individual INR 8,000, the same insurance policy with OPD benefits in a family floater plan would cost INR 32,000. Furthermore, in most insurance plans, this benefit comes at a cap of a maximum of 8 consultations per year for the entire family and a sub-limit of INR 7,000 as medical expense compensation. Hence, health insurance policies with OPD benefits are costlier.

2. More Exclusions

The exclusions under an OPD coverage are far greater than what it actually promises. While it slides cover pharmacy bills, room rent for daycare procedures, and alternative modes of medical treatment; the more immediate and regular medical expenses towards dental treatment, ophthalmology, hearing aids, and external medical procedures like X-Rays, laboratory examinations, and vaccinations are not covered under it. In addition, it does not consider the inclusion, diagnosis, or treatment of mental and psychiatric illnesses unless it has been triggered by a bit and as is apparent, it does not seek to ‘comprehensively’ cover all the requirements of a policyholder.

3. Higher Premium

OPD benefits come with a higher rate of premium that often shoots up the total cost of investing or purchasing in a health insurance policy. As the rate of premium increases with the progress of age, sometimes, OPD premiums might exceed 50% of the total sum insured and can even become equal to the same amount. No doubt, it’s affordability and monetary value far outweighs its services quotient.

Now that the basic configuration of OPD benefits is clear, let us look at health card and whether it is an economic alternative to the same or not.

Characteristics of Health Card

Experts argue that a health card cannot be the equivalent economic counterpart of a hospitalization cover, but it comes with certain exclusive features and benefits that offer a discount of medical, health and drug expenses or a nominal monthly or annual membership fee. It is a financial product that helps its holder to save up on their medical costs, with an emphasis on post-hospitalization recovery. Let us look at some of its characteristics.

1. All Expense Coverage

Unlike OPD coverage, health cards do not have an upper cap or a sub-limit on reimbursement of expenses. It guarantees to cover all medical expenses, including cosmetic treatments. It includes the coverage of dental treatment, pathological tests, radiology expenses, as well as pre-existing conditions. It especially seeks to offer financial support to senior citizens who often find it difficult to pay the high premium rates of health insurance providers in return for a higher sum insured amount.

2. Flexibility Of Choice

Holding a health card enables an individual to exercise their flexibility of choice. While health insurance companies with an agreement with a chain of hospitals make it mandatory for people to receive medical treatment from those places themselves, people with a health card can choose to get treated from multiple hospitals and clinics. Under this feature, they are also assured of complete financial coverage for all medical procedures.

3. Discounts

People with a health card can avail a 50% discount on doctor consultations and 10% to 20% discount on their membership fee which is affordable and ranges between INR 1,000 to INR 8,000. In addition, as health cardholders, they can also get 20% discounts on OPD treatment and 50% off on the total cost of any medical treatment. Health cardholders are also entitled to availing of ambulance service at a lower rate and can easily opt for a second medical opinion before any surgical procedure at no extra cost.

Take Away

These are the broad characteristics of OPD coverage and a health card. While both of these financial products seek to offer monetary assistance to individuals in times of need, it is apparent how OPD coverage is more expensive with limited services. In comparison, a health card is more inclusive and offers financial aid for several other instances as well. Keeping in mind its flexibility and affordability, it is wise to settle for a healthy card as it is economically more viable than OPD coverage.

However, the product or option that you choose will ultimately be contingent on your personal and medical needs. This article is only suggestive of the difference between the two and you're free to choose anyone as per your requirements.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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