Day Care Treatment & Procedures in Health Insurance
What is a Day Care Procedure?
Daycare treatments refer to those medical treatments and procedures that need hospitalization, but not for more than 24-hours as to medical advancements and technology, the treatment processes are now a lot 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!
What qualifies as a Day Care Procedure/Treatment?
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 below 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.
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.
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?
Back in the day, health insurance policies only covered treatment and hospitalizations that went beyond 24-hours. However, thanks to medical advancements and technology, many treatments today can be done in much lesser time than before.
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.
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
Daycare procedures go beyond just the operation or surgery. Daycare treatments usually involve many expenses such as that for diagnostics, medications, hospital admission, vitals, injections and post-hospitalization expenses as well.
Therefore, when you put these together; the total bill towards a specific treatment can be really high and this is where your health insurance comes in use, as it financially covers you for your treatment.
FAQs about Day Care Treatment in Health Insurance
Do I need to opt for daycare treatments or is it already included in my health insurance?
Fortunately, no! Daycare procedures are already included in your health insurance. You need not buy a separate add-on for the same.
Are there any daycare procedures for the COVID-19?
No, there are no specific daycare treatments prescribed for the COVID-19.
How many daycare procedures are covered in a health insurance?
The list of daycare procedures covered in a health insurance varies from insurer to insurer. However, most health insurers cover up to 100 different daycare treatments!
Is there a specific amount up to which I can claim for a daycare treatment?
With Digit’s health insurance covering daycare treatments, daycare treatments will be covered up to your total sum insured.
Are daycare procedures covered for seniors?
Yes, daycare procedures are covered for seniors as well.