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!
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.
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.
Let us deep dive into some of the key differences between daycare and OPD treatment in health insurance:
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.
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.
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.
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.
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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Daycare treatment is a procedure which can be completed within a few hours and doesn’t require you to be hospitalised for 24 hours. For example, procedures such as dialysis, chemotherapy, cataract operation, etc. are daycare procedures that can be finished in a single day.
OPD stands for Out-Patient Department where the doctor provides consultation to the patient and might also perform minor surgery. For example, a root canal, minor dressing due to an injury, routine check-up, etc.
The following aspects are included in the OPD cover in health insurance:
Diagnostic tests or X-Rays
Minor surgery or dressing
Doctor’s consultation fees
Vaccination, for some health plans
Most health insurance plans cover daycare treatment. However, it is recommended to check your insurance coverage as it may differ from one insurance policy to another.
The daycare treatment in health insurance covers the medical expenses arising from an operation or surgery that doesn’t require 24 hours of hospitalisation.