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THE HELLODOC DIFFERENTIATOR

Is it Wise to Choose a Health Card Over OPD Insurance?

Health insurance is inevitable in today's inflation hit age. Medical costs are indeed rising at an unabated pace but have you ever wondered your health plan might as well have considerable gaps. Even a proper health policy will not pay for a tooth filling or a broken finger.
Moreover, the cost of dental treatment, diagnostic tests, periodic doctor consultation, preventive check-ups, medicines and medical equipment, called as out-of-the pocket expenses, can disturb your savings routine.
Also, is it OK to pay Rs 15,000 more every year towards your health policy to seek an extra OPD (out-patient department) benefit of only Rs 12,000?

Insurance, a costly affair:

There are health plans in the market that cover both hospitalization and OPD treatment costs on a cashless basis in network hospitals and clinics. There is even coverage for pharmacy bills, diagnostic tests, outpatient dental treatment, contact lenses, spectacles and health checkups. A 3-lakh cover under any company's standard health plan, costs Rs 8,000 for a family of four (two adults and two children, with the eldest member being 35 years), a similar coverage under the plan including OPD treatment would cost you an astonishing Rs 32,000. The rider included features like doctor consultations are restricted to eight per year and there is a sub-limit of Rs 7,000 on various expenses, including diagnostic tests, pharmacy bills, dental treatments and eye care (spectacles and contact lenses).

Let us compare the costs of a Hellodoc health card, a generic health card with Health Insurance (with OPD Coverage)

HelloDoc Health Card

INR699

Per Year

  • Basic Annual Expenses
    Doctor consultation: 1000X12=12,000
    Upto 30%
    INR 3600
  • Cost of medicines :1000X12= 12000.
    Upto 30%
    INR 3600
  • Annual health check-up for 2
    5000X2 = 10,000
    Upto 50%
    INR 5000
  • Dental treatment: 75,00X2= 15,000 = Rs.49,000
    Upto 30%
    INR 14700
  • Discount/reimbursement (flat 30% on Rs. 49,000) =26,900
  • Out of pocket expense Rs. 30,100
  • Settlement < 48 Hours
  • Icing on the cake
  • Accidental Medical Cover INR 20000
  • Death Cover INR 1000000
  • Disability Cover Upto INR 1000000
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Health Card

INR8,000

Per Year

  • Basic Annual Expenses
    Doctor consultation: 1000X12=12,000


  • Cost of medicines :1000X12= 12000.
    Upto 30%

  • Annual health check-up for 2
    5000X2 = 10,000
    Upto 30%

  • Dental treatment: 75,00X2= 15,000 = Rs.49,000


  • Discount/reimbursement (flat 30% on Rs. 49,000) =14,700
  • Out of pocket expense Rs. 42,300
  • Settlement < 48 Hours
  • No Icing
  • Accidental Medical Cover
  • Death Cover
  • Disability Cover


HelloDoc Insurance (with OPD)

INR20,000

(Additional cost with OPD)
Per Year

  • Basic Annual Expenses



  • Cost of medicines :1000X12= 12000.


  • Annual health check-up for 2
    5000X2 = 10,000


  • Dental treatment: 75,00X2= 15,000 = Rs.49,000

  • Discount/reimbursement (flat 30% on Rs. 49,000) =17,200
  • Out of pocket expense Rs. 51,800
  • Settlement <= 30 Days
  • Icing on the cake
  • Accidental Medical Cover INR 20000
  • Death Cover INR 1000000
  • Disability Cover Upto INR 1000000


The exclusions list for health plan with OPD is quite lengthy. Expenses, such as dental treatment, spectacles and contact lenses, hearing aids and other external medical equipment or devices, X-ray and laboratory examinations and investigations, vaccination (unless it is part of post bite treatment) and treatment for any psychiatric illnesses are not covered.

An OPD cover is costly. According to Health insurers, out-patient healthcare services and their coverage typically involves a huge number of transactions. The chances of a person to use the cover multiple times throughout the policy period are also more. Which is why, the monetary value that a customer can get from such a policy is higher than a basic health insurance policy.
Because of higher assumption on incidence rates (nearly 100%), the OPD premium is usually more than 50% of the sum insured and, with increasing age, becomes more than or equal to the sum insured.

Economical Alternative:

Discount cards or health cards are in no way a replacement for hospitalization cover, but are exclusive schemes that particularly give you discounted rates on medical, health and drug expenses for a monthly or annual membership fee. Healthcare plans help members save on medical expenses, with emphasis on pre-hospitalization, but also cover post-hospitalization costs. Offerings, such as discounts on dental treatments, pathology and radiology expenses and doctor consultations, are not covered under a health insurance policy. In case of a health card plan, there are no caps or sub-limits.
Health cards cover almost all healthcare expenses, including cosmetic treatments. It is also of huge help to high-risk people, such as those with pre-existing ailments, and those who are refused health insurance, especially senior citizens, who face refusals or have to shell out huge sums of money as premiums for a policy surrounded with lot many clauses and exclusions.
While a loyalty programme from HelloDoc, you will have access to our 4000+ partners and more importantly convinence and flexibility of choice.
The membership fee of these cards ranges between Rs 699 onwards. Depending on the plan you choose and the number of members registered. A basic plan provides a discount of 15-30% on consultations and 10-20% discounts on OPD treatments and procedures at hospitals. For dental care, you get facilities of free check-ups and up to a 20% discount on the total cost of treatment
There are also offers where you can avail up to 50% discount on doctor consultations at a few network clinics. There are some special add-on benefits as well, including 24x7 diala-doctor and chat service, free second opinion prior to a critical surgery, discount on ambulance charges and online tools like symptom tracker and health records log.
There are certain concessions offered on 'wellness services', such as diet programmes and spa treatments, and alternative treatments, such as ayurveda and homoeopathy

Word of Caution:

Insurance, as we all know, is a regulated industry, whereas a health card provider isn't subject to face any restrictions from a regulated body. Therefore all the grievances would have to be addressed before a consumer court. It is, therefore, asked of you to gather enough information about the company's background before buying a membership. Is it a registered company? For how long has it been in business? Ensure it has tie-ups with couple of reputed names in your city. If the company is not keen on disclosing the network size and partnerships, it would perhaps be wise to check out a customer loyalty membership of the hospital in your vicinity