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Day Care Treatment and Procedures Covered Under Health Insurance

What is Day Care Treatment in Health Insurance?

What qualifies as a Day Care Procedure/Treatment?

Importance of Having Daycare Treatment Cover Under Health Insurance

Non-hospitalization expenses amount to almost twice the hospitalization costs (IRDAI). (1)
Illnesses like cataracts often need day care procedures rather than inpatient care, which accounts for a large part of healthcare expenditure. (2)
Advancements in medical technology have helped many treatments to be completed in less than 24 hours, reducing stress. (3)

Are Day Care Procedures Covered in Health Insurance?

List of Day Care Treatments Covered Under Health Insurance

From eye surgeries to chemotherapy, the day care treatment list never ends. Here is a precise list of diseases that are treated in a day and covered under a daycare treatment in a health insurance policy.

Root canal surgery

Cataract surgery

Kidney dialysis

Tonsillectomy

Angiography

Radiotherapy

Adenoidectomy

Septoplasty

Chemotherapy

Arthroscopy for joints

Minor skin surgeries

Piles surgery

Immunotherapy

Oral chemotherapy

Stem cell therapy

Bronchial Thermoplasty

Disclaimer: The above list of daycare treatments is for representation purposes only. Please refer to your specific policy document to understand the treatments covered by your insurer, as the list may vary based on your health insurance plan.

What is Covered and Not Covered in Day Care Treatment Under Health Insurance?

So far, we know that Day care treatment only includes the treatment that are done within 24 hours. However, not all treatment are included. It is essential to review your policy for a complete understanding of what is covered and excluded under the day care procedure in your health insurance.

What is Covered in Day Care Treatment?

What is Not Covered in Day Care Treatment?

Medical costs related to any surgery, treatment, or operation that requires the policyholder to spend fewer than 24 hours in a hospital are covered by day care coverage in health insurance.

Not all short-term medical procedures are covered by health insurance for day care services. Procedures overseen by the Outpatient Department (OPD) do not qualify as day care services.

Dialysis, chemotherapy, eye surgery, and any other illness or injury that requires only a few hours of hospitalization are excellent examples of day care treatments.

For instance, OPD takes into account routine visits, seasonal illnesses, minor injuries and medical consultations. Since these operations don't involve significant surgery, they aren't considered day care services.

Things to Know About Day Care Treatment Coverage in Health Insurance

Benefits of Day Care Procedure Coverage in a Health Insurance

What is the Difference Between a Day Care Treatment and OPD Treatment Cover?

Many of you might get confused between a daycare procedure and outpatient department treatment, but they are a Day Care treatment is widely different from a day:

Factors

Daycare Treatment

OPD Treatment

Meaning

Day care procedures refer to treatments requiring hospitalization, but only below 24-hours due to medical advancements.

OPD translates to Out Patient Department and refers to daily doctor consultations or smaller treatments like minor stitches and fractures.

Hospitalization

Hospitalization required < 24 hours

No hospitalization required

Examples

Examples of daycare procedures include cataract surgery, chemotherapy, ligament tear, kidney dialysis, corneal incision and radiotherapy, among many others.

Examples of OPD include regular doctor consultations for any illness or disease, such as for a seasonal flu, minor dressing due to an injury, regular health checkups and consultations among others.

Coverage

Health insurance usually covers daycare procedures up to the total Sum Insured. This includes all pre and post-hospitalization expenses related to the daycare treatment being claimed for.

OPD benefits or OPD covers in health insurance are usually limited up to a specific amount and differs from insurer to insurer. For example, many health insurers offer OPD, up to Rs 5,000 per year.

How to File a Claim for Day Care Treatments?

FAQs about Day Care Treatment in Health Insurance