When Rahul Khandekar’s 12 year-old daughter was diagnosed with dengue, just the cost of doctor consultations and medical tests crossed ₹10,000. But since there was no hospitalisation, these costs were not covered by his insurance policy.
Looking to bridge this gap between medical expenses incurred and insurance coverage are a number of health cards or discount cards.
These are special schemes that give you discounted rates on medical, health and drug expenses for a monthly or annual membership fee. And while insurance covers post-hospitalisation expenses, health cards offer discounts at OPD (out-patient department) visits at individual doctors, dentists, laboratories, pharmacies, hospitals, nursing homes and medical centrer.
Indian Health Organisation (IHO), owned by US based insurance giant Aetna, is the largest company operating in this space. It provides preventive healthcare services in the form of a Health Card. The card provides concessional benefits to its members through a network of 15,000 medical partners spread across 35 plus cities.
For example, at IHO network doctor clinics, you get a 50 per cent discount on consultation and 20 per cent off on further treatment.
“Healthcare in India typically consists of curative and preventive care, insurance in India covers predominantly curative side when one is hospitalised and in that too there are grey areas such as waiting periods for pre existing diseases and senior citizens,” said Sachin Mehta, Vice-President (product head) at Indian Health Organisation.
Suhas Jadhav, Assistant Vice-president from Bonanza Healthcare, which also recently launched a health card, points out that diagnostic and preventive healthcare costs account for 70-75 per cent of overall medical spends which insurers do not cover.
Sanjay Datta, Chief of Underwriting and Claims at ICICI Lombard General Insurance, points out that while health insurance policies overseas cover both pre- and post- hospitalisation expenses, insurers in India have stayed away from covering OPD as the sector is largely unorganised which makes it prone to fraud. Hence, OPD covers offered by insurers are typically very expensive and come with limits on the amount for each treatment unlike health cards. Jadhav adds that health cards provide a healthcare solution to high-risk people, such as those with pre-existing conditions, and those who are denied health insurance, especially senior citizens, who face exclusions or have to pay extremely high premiums for a policy loaded with too many clauses and exclusions.
However, Deepak Yohannan, Chief Executive and Founder, Myinsuranceclub.com, points out that the main disadvantage of health cards is that companies offering them are not regulated unlike insurers which are regulated by the Insurance Regulatory and Development Authority of India.
Sometimes consumers find the health card wanting when they actually want to use and the only resort to resolve complaints is at consumer courts, he says.
That said, the best bet for consumers is probably to first check with neighbourhood hospitals and nursing homes on whether indeed they can get the promised discounts at these centres.
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