Health Card or OPD Cover which one is better


In this current situation of the virus related pandemic gripping up over almost every village, district and state of our country, people of every income group and occupation have become extremely cautious of their health. Not only the cautiousness level has been increased there is also a great worry amongst many of the financial disturbances they need to face if for any medical emergency they get need to get admitted to a private hospital which may charge the lifetime savings in a matter of few days.

Health insurance has thus become an absolute necessity in these contemporary times and more and more people have started opting for it voluntarily. For some under privileged people governments have come forward to design suitable health insurance programs to cover them, Ayushman Bharat is one such ambitious scheme of government of India.

If we get a normal health insurance policy there will be obviously a few of the things for which it will not grant a cover, although these things can be covered by paying a higher premium either as an add on or in advanced plans but we need to do a very proper cost benefit analysis before going for the same.

There are a few reasons for which a health card is considered a more cost effective way to deal with these extraneous expenses which a health insurance will not cover under ordinary circumstances or will cover the same at an extra premium. Now the question comes that what is actually a health card? A health card is like an identity card which identifies the people covered ad can be issued by the government, a hospital, an NGO, any insurance company or others. It offers a range of benefits and discounts including but not limited to diagnostic tests, OPD consultations, discounts on pharmaceuticals etc.

The aim of this article is the give a comparative account of a health insurance policy with an OPD cover and a health card. Before starting writing the comparative points and at the very outset this should be clear that health card is not at all a substitute for health insurance but can complement it well if taken after a careful consideration of cost and benefit.


  • As far as OPD cover is concerned, it is not covered by default under a normal health insurance policy and is needed by every Indian household quite frequently, can be managed to be covered under a health card. Now say we take a high end health insurance plan which will cost you approximately 15-20k more for incorporating OPD cover along with a few others and that too with a cap on the benefits like say four OPD visits annually whereas a health or discount card will cost you anything generally between 5-8k and will offer you a genuine discount of around 15-30% on OPD consultations and visits. If we do rest of the math on our own according to the number of such consultations we generally take in a year, we will see a benefit by taking a health card for such purposes.


  • The same as mentioned above is true for various other coverage like outpatient dental treatment, spectacles and contact lenses, visual and hearing aids, other external devices, diagnostic tests, vaccinations and medicine bills. These are some of the long list of exclusions as a part of OPD treatment. It is evident and clear that a bunch of these expenses will either not be covered under your health insurance or even if you pay a hefty price to get these covered it will be bound to burn a big hole in your pocket as there will be standard capping and restrictions for this. The best way to manage this is to get enrolled under a decent health card and get great discounts and save the burden to your pocket.


  • In case of hospitalization or some serious disease which may require a continuous prolonged treatment the health card and the discounts provided by it will not at all be sufficient to cope up with the costs. Then only the health insurance policy for which you have paid premium from your hard earned money will turn out to be a saviour and save you from financial trouble.


  • Insurance is a heavily regulated industry and there are various forums made and available under various laws and amendments like insurance ombudsman were the policyholder can reach in case of a dispute or non-satisfaction. One of the primary functions of the regulator IRDAI is to behave as a watch dog so that no unfair practices of customer cheating and fraud can prevail in the market. Health card in the contrary is subject not to any such special forums or regulator and consumer forum is the only way for any grievance redressal and complaint resolution.

It is thus advisable to have a health card for OPD services and related expenses as mentioned in the article and do not get unnecessary premium burden to get these combined with regular health insurance. And keep the health insurance separate for its core purpose which is inpatient hospitalization and treatment of serious diseases. The purpose of keeping these two things separate should be clear and by this will surely result in saving a few bucks for the policyholder and his family and will ensure complete all round protection and peace of mind.


MCQ’s on General Insurance Licentiate Exam : IC 01 / IC 11 / IC14 (Total 300)

IC 85 Reinsurance Management: III Associate Exam – Multiple choice questions

IC 47 A-1 Foundations of Casualty Actuarial Science Part 1 – 100 MCQ’s

Sharing is caring!