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Day Care Treatment & Procedures in Health Insurance

What qualifies as a Day Care Procedure/Treatment?

Why are Day Care treatments important in a Health Insurance?

Non-hospitalization expenses amount to almost twice the hospitalization costs (IRDAI). (1)
Illnesses like cancer and kidney failures often need daycare procedures as part of overall treatment such as chemotherapy and dialysis respectively which accounts for a large part of healthcare expenditure. (3)
Advancement in medical technology have helped many treatments to be completed in less than 24-hours. (2)

Are Day Care Procedures covered in a Health Insurance?

What is the difference between a Day Care Procedure and OPD?

Daycare Procedures

OPD

What does it mean?

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

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

Hospitalization

Hospitalization required, < 24 hours

No hospitalization required

Examples

Examples of daycare procedures include chemosurgery to skin, skin transplantation & restoration, ligament tear, cataract operation, corneal incision, radiotherapy and chemotherapy 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.

What’s covered?

In a health insurance, daycare procedures are usually covered up to the total Sum Insured. This includes all pre and post hospitalization expenses towards the daycare treatment being claimed for.

OPD benefits or OPD covers in a 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.

Advantages of Day Care Procedure & Treatments in a Health Insurance

FAQs about Day Care Treatment in Health Insurance