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Health Insurance with OPD Cover v/s Health Card: A Comprehensive Study

By Juhi Walia
04 October 2022, 1:17 PM

In recent years, we have witnessed the enormous rise in medical costs and there exist certain gaps in your comprehensive health insurance plan that are never all-inclusive. You need to bear certain medical costs out of your pocket that can comfortably burn a hole, especially for dental treatment, periodic doctor check-ups, diagnostic tests, etc. You can ensure health insurance with OPD coverage, but there are more affordable wise options offering better value for money. Here, a health card comes into the picture. 

What is Health Insurance?

Health insurance is a deal between the health insurance provider and the policyholder, where the latter needs to make certain deposits, which are technically termed as premiums to the former. In case of any medical emergency, you make a claim, and the concerned insurance provider covers all the associated medical costs as per the norms of the concerned plan, mentioned in the policy papers.

Health insurance keeps you ready to face any sort of medical emergency, and the benefits are not solely restricted to financial safeguards only. It offers a host of other benefits too. For these reasons, a larger number of people are nowadays opting for health insurance packages. 

However, a deeper understanding of the circumstances might make you think about your decision for investing in health insurance when other comparatively more affordable options are available. 

In case you are opting for a dental appointment or suddenly encounter a minor accident resulting in a broken finger, your health insurance might be incapable of covering these. It may seem to be negligible initially, although subsequent medical visits and a host of investigations might well burn a big hole in our pocket, leaving you entirely incapable of availing of health insurance benefits under most circumstances. 

Health Insurance: Economical or Extravagant Option?

Several health insurance providers include OPD costs too, which are technically termed as health insurance with OPD coverage. These are particularly meant for routine medical check-ups at certain intervals. Although health insurance with OPD coverage allows tax benefits under Sec 80D of the IT Act,  when the premium cost is compared and considered, it might seem to be an extravagant option, when the investigation costs are significantly lower. 

Although a competent health insurance plan pays for various types of critical illnesses along with other medical conditions, it is a wise decision to consider the costs which you merely require only under certain specific circumstances. 

Health insurance with OPD coverage comes along with a certain set of benefits and disadvantages too. There are plenty of expenses that do not come under the purview of the insurance coverage, and it is a hefty list, including:

  • Dental treatment costs
  • Optical equipment, including contact lenses and specs
  • Hearing aids
  • Medical equipment
  • Diagnostic investigations
  • Vaccinations
  • Psychiatric treatments

The average annual premium of a non-smoking male aged between 35 and 65 years ranges between INR 10000 and INR 71000. Moreover, the additional top-up combinations may range between INR 5000 and INR 41000 for similar age criteria. Therefore, it is quite evident that health insurance is not essentially a pocket-friendly option. This makes it vital to seek other plausible alternatives. 

Health Cards: A Reasonable Alternative

The health care policies are certain exclusive schemes that exercise no exception in case of any emergency medical conditions. The health cardholders are issued with a physical card, these days, an e-card, for availing of the associated benefits of the concerned plan in exchange for a regular membership fee. 

Such healthcare plans include multiple hospitals, clinics, laboratories, and nursing homes within their network offering enhanced flexibility. These plans offer coverage for almost all sorts of medical expenses and, under certain circumstances, for cosmetic treatment costs too. 

Generally, people with pre-existing conditions always fall incapable of securing their health with a health insurance scheme. Under such circumstances, a health card saves the day. 

Following the government scheme of Ayushman Bharat, the government has transformed nearly 2 lakh sub-centres into wellness centres, issuing electronic cards to every Indian citizen visiting these centres. These are not only membership cards, but at the same time, act as a repository of the concerned cardholder's previous medical records and history. Using this card, the identity of the cardholder can be easily obtained even if he/she is in an unconscious state. 

Major Benefits of Health Card

Some of the major highlighting benefits of a health card are as follows:

  • Reasonable membership fee, amounting from a few hundred to few thousand, comparatively much cheaper than a standard health insurance plan
  • Considerable discounts on treatments and OPD consultations
  • Exclusive dental care coverage
  • Attractive medical vouchers result in savings
  • Follow-up medical consultations and investigations
  • 24/7 doctor-on-call availability
  • Allowing a second opinion before undergoing any surgeries
  • Discounts on ambulance charges
  • A comprehensive electronic health log, recording all the relevant details
  • You can easily contact the concerned insurance company in case of any assistance
  • The plan details can be easily obtained in a minute
  • The card specifies the date of validity
  • The health card clarifies the health insurance claim eligibility

Apart from these, certain companies even offer exclusive wellness programs including gym services, diet programs, alternative medical treatments, spa therapies, etc.


Both health insurance and health cards have their individual sets of advantages and disadvantages. It depends on the concerned service seeker, and what kinds of services he/she desires to avail of. But, before choosing anything, you must understand all the associated terms and conditions well, and then make the decision wisely. A well-chosen scheme can prove to be a perfect companion in case of medical need.  

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1. Is OPD covered by health insurance?

Most Indian health insurance plans do not offer OPD coverage and are only available as an add-on cover. 

2. How does OPD insurance work?

There is no need for hospitalisation for getting the costs covered under health insurance with OPD coverage. Out-patient costs are also automatically covered. 

3. Is a health card compulsory?

No, there is no compulsion to get registered under ABDM for a digital health card. However, those who desire to be a part of the program can approach it accordingly.

4. What is the benefit of health card in India?

A health card offers coverage of INR 5 lakh per Indian family annually for tertiary and secondary care hospitalisation across private and public empanelled hospitals in the country.

5. What are the major diseases covered by a health card?

Some of the major diseases covered by a health card include heart diseases; RTA and burns; kidney diseases (dialysis); chronic infections like HIV, hepatitis, organ failure, diabetes mellitus, etc.

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