Day Care Treatment and Procedures Covered Under Health Insurance

Daycare treatments in health insurance refer to medical treatments and procedures that require hospitalization, but not for more than 24 hours. These treatments are possible only because of medical advancements and technology which makes the treatment processes are now much shorter!

Popular examples of daycare treatments include cataract surgeries, nasal sinus aspiration, cancer chemotherapy, cancer radiotherapy, etc.

Digit Simplification: Why stay in a hospital unnecessarily when the required procedure takes just a day? 

Note: The important thing to keep in mind about daycare procedures is that, not all short-term treatments are considered as daycare procedures. Hence, the same shouldn’t be confused with OPD consultations.

Daycare treatment strictly refer to treatments, surgeries and operations, that require hospitalization for less than 24 hours due to advancement in medical technologies and procedures.

Whereas hospitalizations of over 24-hours are covered under “hospitalization expenses” in your health insurance, and OPD consultations required for smaller medical concerns like fractures, sprains and other doctor consultations are covered under OPD benefit or OPD cover, as specified by your health insurance policy.

Yes, day care procedures are often covered under health insurance as they provide financial relief in case of emergency. 

These include treatments like cataract surgeries, chemotherapy, radiation therapy, dialysis, hymenectomy, and arthroscopic knee aspirations among many other procedures. 

Given the fact that many such treatments can be done under 24-hours and are not only needed by many patients but also include high healthcare expenditure, the IRDAI (Insurance Regulatory & Development Authority of India) introduced the same in health insurance policies. 

Thank God for that! Thereby, daycare procedures refer to such treatments that require hospitalization of less than 24-hours due to medical advancements. 

A good example of the same would be, when someone has to be admitted into the hospital for a cataract surgery, post which he/she will also receive care at the hospital and then be discharged within the same day itself.

If you have a health insurance plan, you can rest assured that your insurer will cover your day care procedures. However, there are some important things you must know about day care procedure in health insurance:

• Sum Insured: Ensure that the sum insured in health insurance is sufficient to cover the costs of your daycare treatments, ensuring adequate financial protection.
• Inclusions and Exclusions: It is crucial to thoroughly review the policy document to understand which treatments are covered and which are excluded from the day care procedures under your insurance plan.
• Co-payment: Be aware of any co-payment clauses in your policy, as these may require you to pay a portion of the treatment costs out of pocket.
• Waiting Period: This refers to the time frame you must wait before you can claim for a specific condition. It’s important to check the waiting period in health insurnace for the particular treatment you need.

List of Network Hospitals: Review the list of network hospitals your insurer provides. Shortlist the nearby hospitals, making it easier to access cashless claim facilities when needed.

Daycare procedures go beyond just the operation or surgery. Daycare treatments usually involve many expenses, such as diagnostics, medications, hospital admission, vitals, injections, and post-hospitalization expenses. Here are some benefits of daycare hospitalisation procedures in health insurance:

• Financial Protection: Even with their reduced duration, daycare procedures can still be costly. Insurance coverage helps with cost management and protects you in an emergency.
• Broad Coverage: Both major and minor procedures are covered by medical needs. With day care coverage, you're covered for various health situations.
• Convenience: You don't need to stay in the hospital for long to receive the necessary treatments. You will be treated and recover faster. 
• Comfort: Knowing you are insured for these day care treatments helps ease your anxiety about any medical problems.
• Faster Access to Treatment: You might receive the care you require more quickly because day care procedures sometimes have shorter waiting times than inpatient procedures.

Claiming a daycare procedure is almost similar to making a claim for an inpatient treatment. The claim process depends on the hospital you choose. If you have opted for a network hospital, you can go for a cashless claim and if you have selected a non-network hospital, you can make a claim through a reimbursement claim process.

Cashless Claim:

Step 1: Notify your insurer and select a network hospital for your day care surgery before your hospitalization.

Step 2: Show your e-health card at the network hospital helpdesk and ask for the pre-approval.

Step 3: Fill out and sign the form and submit it to the helpdesk.

Step 4: After verification, the insurance company will take care of your day care treatment.

Reimbursement Claim:

Step 1: If you select a non-network hospital and undergo a daycare procedure, keep all the medical bills, reports, and other essential expense documents with you.

Step 2: After treatment, contact your insurer and provide them with all the soft copies of the documents and bank account details for reimbursement of expenses. 

Step 3: The insurer will verify the documents, and you will receive a reimbursement for the daycare procedure expenses.

In today’s fast-paced world, daycare treatment coverage in health insurance is like having a safety net for life’s smaller medical surprises. So whether it’s a minor or major surgery, knowing your insurance has you covered means you can focus on your recovery rather than worrying about your bills.