Daycare Treatment VS OPD Treatment

Have you ever regretted not comparing your health plan to find the best one? You might have noticed that certain medical care aspects are not included in your plan. This is why it is crucial to go through the coverage of your policy and ensure that features like daycare procedures, alternative treatment, OPD treatment, etc. are covered. But you might be under the impression that daycare and OPD treatment are the same. Although both these healthcare facilities are somewhat similar, they are quite different from each other!

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024. The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

What is Daycare Treatment?

Daycare treatment is a medical procedure that does not require hospitalisation for 24 hours and can be completed within the same day. Such minor surgeries or procedures can be finished within a few hours under general or local anaesthesia. Some common examples of daycare procedures are cataract surgery, radiation, dialysis, dental procedure, etc.

What is OPD Treatment?

Out-Patient Department or OPD treatment cover is where the patient visits the doctor for consultation or treatment and does not require hospitalisation. For example, if the insured experiences stomach aches, they will seek medical care under OPD treatment. In case a health plan provides OPD coverage, then it shall cover the doctor’s consultation fees, medications, pathological tests prescribed by the medical professional, etc. Some examples of OPD treatment are root canals, minor surgeries, wound dressing, etc.

Know the Difference Between Daycare and OPD Treatment

Let us deep dive into some of the key differences between daycare and OPD treatment in health insurance:

• Coverage Amount

Most health insurance plans offer coverage up to the sum insured limit for daycare procedures. However, this may vary from one insurer to another. But this is not the case for OPD treatment as insurance providers may include a sub-limit clause. Here, the OPD expenses shall be covered up to a specified limit and you might have to bear any additional costs incurred during the consultation.

• Scope of Coverage

One of the most crucial differences between OPD and daycare treatment is that most insurers do not offer OPD coverage. You can easily find health plans providing coverage for daycare procedures with varying features and the number of treatments covered. But OPD cover is often excluded from health insurance. 

• Hospitalisation

As we mentioned before, OPD treatment does not require hospitalisation and consists of consultations or minor treatments. Whereas, daycare procedures require hospitalisation for a few hours where the surgery or operation can be completed within a single day. Previously, policyholders had to be admitted for at least 24 hours to raise a health insurance claim but daycare treatment has eliminated that requirement.

• Insurance Claims

The claim process for daycare treatment is similar to that of a hospitalisation claim. The insured can opt for a cashless facility at a network hospital and avail the medical care. However, the same cannot be said for OPD treatment as the policyholder might have to file a reimbursement claim after submitting the necessary documents. But make sure you always inform the insurance company beforehand regarding the healthcare treatment to avoid claim rejection.

Conclusion

It might be difficult to understand the differences between these two terms just by reading the definition. But daycare and OPD treatment have become vital in health insurance as they offer financial coverage for various medical procedures. Now that you know the features of both these medical facilities, you must ensure that your health policy includes them while purchasing a plan! By comparing various policies online, you can make sure your health plan offers coverage for daycare as well as OPD treatment.

 

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