Day Care Treatment Covered Under A Health Insurance Plan
29 June 2022
Insurance companies have provided for day care treatments to keep up with the fast-paced evolving medical science technology. Medical procedures that used to require prolonged hospitalisation can now be done in a single day. Day care procedures now include a wide range of medical procedures such as eye, nose, and ear surgeries and orthopaedic and oncological procedures.
What is a Day care Treatment?
A day care treatment is a medical procedure in which patients are discharged within one day. Many medical treatments that previously required prolonged hospitalisation can now be completed in a matter of hours, thanks to advances in medical science. These medical procedures fall under the purview of day care treatment.
What is a Day care Procedure?
A day care procedure is a medical treatment and procedure that require hospitalisation but not for more than 24 hours. Due to medical breakthroughs and new tech, treatment methods are now much shorter.
Day care treatments include cataract surgery, nasal sinus aspiration, cancer chemotherapy, cancer radiotherapy, and other procedures.
People frequently mix up day care treatment and OPD consultations. It is important to note, however, that not all brief medical treatments are considered day care procedures. Day care treatment refers to treatments, surgeries, and operations that require you to be hospitalised for less than one day.
When hospitalisation and treatment procedures last longer than 24 hours, the costs are covered by your health insurance plan as hospitalisation costs. Smaller medical consultations, such as sprains, fractures, and other doctor advice, on the other hand, are covered under OPD benefits.
Day Care Treatment List
One should carefully read their health insurance policy document to learn about the scope of coverage in day care procedures. The following are some of the more common things that are covered in day care treatment.
Day care Treatment List
Cataract surgeryRemoval of foreign bodiesCorneal abrasionOperation tear ductIncision of the eyelidCorrective surgery for entropion/ectropion
Sinus & Nose
Aspiration of the nasal sinusesSurgical procedure on the nasal conchaOther nose surgeriesRemoval of foreign bodies
StapedotomyAuditory ossicle proceduresTympanoplastyOperations on the middle earReconstruction of the middle earIncision in the inner earOther procedures involving the inner ear
Reconstruction of the tongueGlossectomyOther tongue-related operations
Subcutaneous Tissue and Skin
Skin graft and skin regenerationSkin chemosurgerySkin and subcutaneous tissue incisionsDiseased skin and subcutaneous tissues are excised.
The mouth has undergone plastic surgery.Mouth, jaw, and face incisionsOther procedures involving the mouth and face
Meniscus and ligament surgeryTrauma and orthopaedic surgeryTendon fractures and suturesSurgery for a dislocationOther joint and bone procedures
All costs, including room and board, as well as the fees of specialists, consultants, surgeons, and anaesthetists, will be covered for the medical procedures. In addition, medical expenses such as prosthetic devices, medicines/drugs, orthopaedic implants, vascular stents, X-rays, medical reports, surgical appliances, operation theatre charges, and so on are also protected under day care treatment.
How to Select a Day Care Health Insurance Plan?
Most health insurance companies emphasise the “number” of day care procedures covered under their policy to entice customers. As a result, inexperienced health insurance buyers select a health insurance plan with the most day care procedures.
However, the number of day care procedures listed in medical insurance plans is not the only factor to consider before investing. The cashless facility, co-pay, sub-limit, age limit, and so on are all important considerations when choosing a health insurance policy.
Quantity vs Quality
It is best to think of the treatments covered by day care procedures in a broader ‘conceptual’ context. Rather than looking at 200+ names of separate isolated surgeries, looking at 20-30 wider categories like oncology, urology, and so on is a more realistic, effective, and complete approach, as these broad umbrellas cover dozens and dozens of therapies.
Furthermore, it is preferable to use broad categories that even a layperson can understand for all intents and purposes. Besides, an insurance company that provides a detailed list of specific procedures may refuse to cover future treatments that emerge as a result of medical science progresses.
When comparing plans with similar features and benefits, choose the one with broader categorisation or, even better, with all-inclusive day care procedures.
Coverage by Category
The broad categories of day care procedures are usually listed by public sector insurers. The benefit is that if a specific category of day care procedure is not listed at the time of policy purchase, one can request its inclusion from third-party executives before treatment begins.
Filing Day Care Claims for Health Insurance
Because day care procedure coverage is an in-built policy feature, the process for filing day care claims is similar to that of a regular health insurance policy. Cashless procedures can be used for planned procedures; however, some companies require advance notice.
In other instances, insurers reimburse after the required documents are submitted. For example, the provisions for pre-hospitalisation and post-hospitalisation benefits remain unchanged – the insurance company reimburses the policyholder for hospitalisation expenses incurred.
Coverage for Outpatient Department (OPD), Dental, and Maternity
Some insurance companies provide policies with the unique selling point of covering maternity, outpatient departments (OPD), and dental expenses. These insurance cover treatments that do not necessitate 24-hour hospitalisation and do not fall under the category of day care operations.
Why are Day care treatments Important in Health Insurance?
There are many reasons why day care treatments are important. Some of the day care treatments in health insurance are listed below:
Diseases such as cancer and kidney failure frequently require day care procedures as part of overall treatment, such as chemotherapy and dialysis, which account for a significant portion of healthcare expenditure.
Many treatments can now be completed in less than 24 hours, thanks to advances in medical technology.
Inclusions in a Day Care Treatment in Health Insurance Benefits
If one is looking for the best health insurance policy, remember to get one that includes daycare treatment. It may provide them with the following advantages:
Excellent medical care: Users no longer have to be concerned about the quality of medical treatment when they have a health insurance policy that includes a day care treatment facility. Cashless, cutting-edge medical treatment is available at a large network of network hospitals. These hospitals have highly trained medical practitioners and staff to provide cutting-edge hospital facilities.
Claims without cash: A health insurance policy’s day care procedure provides financial assistance at the critical time of receiving medical treatment via cashless service. To take advantage of this important benefit, you must notify the insurance company in advance of your upcoming day care procedure. You can receive medical treatment without paying cash with a pre-approved request. Instead, the insurer will pay the medical bills directly.
Tax advantages: Did you know that having a health insurance policy with a day care procedure facility can also provide you with additional tax benefits? You can get tax breaks if you pay your health insurance premiums as a deduction under Section 80D of the Income Tax Act.
CDC Health Advantage: This is a key highlight of Finserv MARKETS’ Health Insurance, also known as Click by Direct Claim (CDC). This one-of-a-kind app-based feature allows you to easily and quickly file and settle claims up to Rs 20,000. To file a claim, you must use the Insurance Wallet app. The claim amount will be transferred to your account shortly after you provide the necessary details, such as discharge date, estimated expenses, and details about diagnosis and treatment.
Complete peacefulness: The last thing you need during a critical period of medical treatment is stress and worry. The guaranteed quality of treatment at an arraigned network hospital, combined with financial assistance, ensures that you receive any day care procedure with complete peace of mind.
As previously stated, people frequently mix up OPD coverage and day care procedures. The below table will allow you to understand the distinction between the two.
Day Care Treatment
The term “day care treatment” means medical treatments that require hospitalisation for less than one day due to advances in medical technology.
When it happens to come, OPD benefits refer to the costs of routine doctor’s appointments or minor medical interventions such as minor sutures and broken bones.
Need for Hospitalisation
Yes, for a period of fewer than 24 hours.
It is not required.
Day care expenses are covered by a health insurance plan up to the sum insured amount. It also includes the costs of pre- and post-hospitalisation for the relevant day care treatment.
OPD coverage or benefit in health insurance has a cap amount that varies by insurer.
Among the many day care procedures are chemosurgery to the skin, ligament tear, skin transplantation and restoration, corneal incision, radiotherapy, cataract operation, and chemotherapy.
OPD includes, among other things, regular doctor consultations for any illness or disease, such as minor dressing due to an injury, the seasonal flu, and regular health consultations and check-ups.
Things to Remember Before Availing Day Care Treatment
The treatments covered by OPD benefits differ from those covered by day care benefits. So, while OPD covers dental cleaning, dental surgery is covered by day care procedures. Knowing the distinction between the two will assist you in submitting the appropriate claim request to your insurer.
Avoid purchasing a health insurance policy based solely on the policy’s day care procedures. Examine the fine print of your health insurance policy and get any questions answered before signing the contract.
Always remember to submit original prescriptions, medical reports, and other documents to the insurance company. If users fail to submit the required documents when filing a claim, their claim may be rejected.
The day care treatment claim process is similar to the health insurance claim process. As a matter of fact, one must always proceed in a time-bound manner. Along with timely claim submission, don’t forget to notify the insurance company a few days before any planned day care procedure.
A common misconception among people is that health insurance companies only cover medical treatment that requires a long duration of medical attention. This is, however, incorrect. Health insurance policies now cover day care treatments too. Users can narrow down the various Health Insurance policies available on Navi to find the best plans that provide quality medical alternatives.
FAQs on Day Care Treatment
Q1. Are there any COVID-19 day care procedures?
Ans: No, no specific day care treatments have been prescribed for the COVID-19.
Q2. Is the senior day care procedure covered?
Ans: Yes, the day care procedure is also covered for seniors.
Q3. Is there a maximum amount limit I can claim for a day care treatment?
Ans: Health insurance plans for day care treatments will cover day care treatments up to your total sum insured.
Q4. Is it necessary for me to choose day care treatments, or does my health insurance already cover it?
Ans: No, your health insurance already covers day care procedures. Therefore, you do not need to purchase a separate add-on for this.
Q5. What number of day care procedures are covered by health insurance?
Ans: The list of day care procedures covered by health insurance varies by insurer. Most health insurance companies, however, cover up to 100 different day care treatments.
Before you go…
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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