Day Care Treatment & Procedures

Day care treatment is a medical treatment or procedure where a patient is discharged from the hospital within 24 hours of admission. Such procedures are usually either non-invasive or minimally invasive, and require very little hospitalisation. 

Health insurance plans that cover day care treatments generally tend to offer coverage for almost all the expenses in connection with the procedure. This includes nursing expenses, room charges, surgeon fees, consultation fees, anaesthetics, medicines, surgical devices, and post-hospitalisation expenses.  

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What Qualifies as a Day Care Treatment?

People often confuse day care treatment with OPD consultations. However, it is essential to understand that not all short-term medical treatments are regarded as day care procedures. When we talk about day care treatment, it means treatments, surgeries, and operations where you need to be hospitalised for less than 24 hours.

 

When hospitalisation and treatment procedures exceed the 24 hours timeline, the expenses for the same are covered under hospitalisation costs in your health insurance plan. On the other hand, smaller medical consultations such as fractures, sprains, etc. are covered under OPD benefits.

Best Health Insurance Plans with Plans with Day Care Treatment

Check out some of the best health insurance plans that offer a wide range of features along with the day care treatments. The table below gives a quick insight into the features and premium of some of these plans:

Health Insurance Plans

Premium Rate

Features

Check Plans

 

 

 

 

Aditya Birla Activ Assure Diamond

 

 

 

 

₹6,371/annum

  • Day care treatment for even less than 24 hours hospitalisation

  • Worldwide emergency assistance to transfer the patient back and forth from home to any hospital in the world

  • Annual health check-up

  • Pre and post hospitalisation expenses

  • Organ donor expenses

  • AYUSH in-patient treatment

  • Family floater policy available

  • No waiting period for cases of accident

 

 

 

 

 

 

 

 

 

 

Bajaj Allianz Health Guard Plan

 

 

 

Plan-specific premiums

  • Day care treatment available

  • Pre and post-hospitalisation expenses covered

  • Organ donor expenses covered

  • Preventive health check-up feature

  • Option of family floater plan available

  • Policyholders up to age of 45 years need no medical check-up

 

 

 

 

 

 

 

Care Plus Health Insurance Plan

 

 

Plan-specific premiums

  • Complete and comprehensive coverage for your whole family

  • Available as family floater and individual policy

  • Sum insured up to 25 lakhs

  • Over 19,000 network hospitals to get casheless treatment in

 

 

 

Day Care Treatment List

You must read your health insurance policy document carefully to know about the scope of coverage in day care procedures. Following are a few standard things that are covered in the day care treatment. 

Operations Covered in Daycare Procedures

Eyes

  • Cataract operation

  • Foreign body removal

  • Corneal incision

  • Tear duct operation

  • Eyelid incision

  • Entropion/Ectropion corrective surgery

Nose & Sinus

  • Nasal sinus aspiration

  • Operation on the nasal concha

  • Other nose operations

  • Foreign body removal

Ear

  • Stapedotomy

  • Stapedectomy

  • Auditory ossicle operations

  • Tympanoplasty

  • Middle ear operations

  • Middle ear reconstruction

  • Inner ear incision

  • Other operations related to the inner ear

Tongue

  • Tongue reconstruction

  • Glossectomy

  • Other operations related to the tongue

Bones

  • Ligament and meniscus tear surgery

  • Orthopaedics and trauma surgery

  • Fractures and sutures on tendons

  • Dislocation surgery

  • Other joint and bone-related surgeries

Skin & Subcutaneous Tissue

  • Skin transplantation and restoration

  • Chemosurgery to skin

  • Incisions to the skin and subcutaneous tissue

  • Excision of diseased skin and subcutaneous tissues

Face

  • Plastic surgery on the mouth

  • Incisions to the mouth, jaw, and face

  • Other operations to the mouth and face

Other Operations

  • Lithotripsy

  • Coronary angiography

  • Haemodialysis

  • Radiotherapy

  • Chemotherapy

All costs, including room, boarding, and nursing expenses, along with the fees of surgeons, consultants, specialists, and anaesthetists will be covered for the medical procedures. Further, medical expenses, like the cost of prosthetic devices, medicines/drugs, orthopaedic implants, vascular stents, X-rays, medical reports, surgical appliances, operation/theatre charges, etc. are also covered under the day care treatment in health insurance.

Why are Day Care Treatments & Procedures Crucial in Health Insurance?

The cost of hospitalisation is rising especially amid the rising cases of pandemic and health concerns. Hence, it is essential that you have all-round health insurance coverage to skip medical expenses from your pocket. Dar care treatments can be quite financially exhaustive, hence, there are several reasons why you must not skip on this cover:

 

  • Non-hospitalisation expenses

In some cases of illness, the cost of non-hospitalisation can surpass the cost of treatment. So, in such a case, if you do not have day care treatment in health insurance, you may have to spend a lot from your pocket

 

  • Overall treatment

Certain illnesses and diseases like cancer or organ failures can include a long day care procedure and it can heavily impact the overall bills of your treatment. So, why pay from your end when your insurance provider is here to cover the cost?

 

  • Quick treatment

Not all illness conditions need long hospitalisation. Some of these can be treated within 24 hours. Since most health insurance plans allow claims only if the hospitalisation exceeds 24 hours, it is essential to have a cover of day care treatment in health insurance. It helps you save medical expenses even if you do not have to be hospitalised for less than 24 hours.

Benefits of Including Day Care Treatment in Health Insurance

If you are planning to purchase the best health insurance policy, always remember to have a policy that includes day care procedures. It can provide you with the following benefits:

 

  • Top-Notch Medical Care

With the day care treatment facility in a health insurance policy, you no longer have to worry about the quality of medical treatment. You can avail cashless, cutting-edge medical treatment at a wide network of empaneled network hospitals. These hospitals have well-trained medical practitioners and staff to provide the right services.

 

  • Cashless Claims

The day care procedure, in a health insurance policy, provides financial assistance at a critical time through cashless health services. For availing this key benefit, you have to inform the health insurance company about the details of your day care procedure in advance. With the pre-approved request, you can receive medical treatment, without having to pay cash. The medical bills will be directly settled by the insurer.

 

  • Tax Benefits

Did you know? A health insurance policy, equipped with the day care procedure facility, can also provide you with additional tax benefits. You can avail tax benefits on making premium payments towards your health policy, as a deduction under Section 80D of the Income Tax Act, 1961.

 

  • Health CDC Benefit

Claim by Direct Click (CDC) is a key highlight of health insurance that is available on Bajaj Markets. This unique app-based feature allows you to raise and settle claims of up to ₹20,000 in a hassle-free manner. Here, you have to use the insurance wallet app to make claims. Once you provide the requisite details, including discharge date, an estimate of expenses, and details about the diagnosis and treatment, your claim amount will be shortly transferred to your account.

 

  • Complete Peace of Mind

The last thing you need at the critical time of undergoing medical treatment is stress and worry. The assured quality of treatment at an empaneled network hospital, along with the financial assistance, ensures that you undergo treatments with zero worries and complete peace of mind.

Which Day Care Treatment Procedures are Covered Under Health Insurance?

All health insurance plans usually include coverage for day care treatments in health insurance. However, the list of procedures covered under this feature may differ from insurer to insurer. Let us explore these treatments in the next section.

 

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What is Not Covered Under the Day Care Treatment Facility

There can be certain medical procedures, like cosmetic surgery, that are not covered under the day care treatment facility. Unless such surgeries are required to save the life of the policyholder, they will be on the list of exclusions. Out-patient Department (OPD) treatments, like dental cleaning, will not be covered under the day care treatment facility. Insurance companies also do not reimburse the cost of surgeries or any medical treatment availed as an OPD patient.

What Makes a Medical Treatment Eligible as a Day Care Procedure?

The eligibility criteria for treatments under the day care procedure cover come down to 3 factors:

 

  • The procedure must be medically necessary.

  • The patient must be admitted to the hospital for this treatment.

  • The medical procedure/treatment should take less than 24 hours.

How to File a Claim for Day Care Treatment

The process to raise claims on day care procedures is the same as raising claim requests on hospitalisation expenses. Your insurer will process the day care treatment claim as a part of your health insurance cover. Let’s understand the steps to raise cashless and reimbursement claims:

Cashless Claim via Network Hospitals

  • Step 1: Go to the nearest network hospital for your day care treatment in health insurance and inform the insurance provider about the procedure before being hospitalised.
  • Step 2: The hospital shall share the same information with your insurer to confirm that the treatment comes within the terms and conditions of their day care procedure cover.
  • Step 3: Once the procedure is done, the hospital shall receive all medical payments from the insurer based on the terms of your insurance cover.

Reimbursement Claims via Non-Network Hospitals

  • Step 1: Choose a non-network hospital for the procedure and inform your insurer about the hospitalisation.
  • Step 2: Pay all the required treatment-related costs from your own pocket.
  • Step 3: Submit a soft copy of important documents to raise a reimbursement claim for day care treatment.

Difference Between Day Care Treatment and OPD

As stated earlier, people tend to get confused between OPD cover and day care procedures. The table below will help you understand the difference between the two.

 

Day Care Treatment

OPD Cover/Benefit

Definition

Day care treatment refers to the medical treatments that need hospitalisation for less than 24 hours.

When it comes to OPD benefits, it refers to the expenses for day-to-day doctor’s consultations or smaller medical treatments such as minor stitches and fractures.

Need for Hospitalisation

Yes, for less than 24 hours

Not needed

Coverage

In a health insurance plan, daycare procedures’ expenses are covered up to the sum insured amount.

It also includes the pre- and post-hospitalisation costs for the concerned day care treatment.

OPD cover/benefit in health insurance has a cap amount, which varies from insurer to insurer.

Things to Keep in Mind Before Availing Day Care Treatment

Here are a few things you must keep in mind before availing the day care treatment: 

 

  • The treatments covered under OPD benefits are different from day care treatments in health insurance. So, while a dental clean-up is covered under OPD, dental surgeries are covered under the daycare procedures. Knowing the difference between the two will help you raise the right claim request with your insurer.

  • Avoid buying a health insurance plan solely based on the day care procedures covered under the policy. Go through the fine print of your health insurance document and get your queries resolved before signing the deal.

  • You must always remember to submit the original documents of your prescription, medical reports, etc. to the insurance company. If you fail to submit the required documents while filing a claim, it can result in rejection.

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FAQs on Day Care Treatment

  • ✔️Do I have to opt for day care treatments when buying health insurance?

    No. Day care procedures are usually covered in a health insurance plan and you do not have to purchase a different add-on cover to avail its benefits.

  • ✔️Do we have a certain limit up to which you can claim for day care treatments?

    Depending on your insurer, the daycare procedures are covered up to the sum insured amount that is chosen by you at the time of buying the health insurance policy.  

  • ✔️Does senior citizen health insurance cover day care treatments?

    Yes. Senior citizen health insurance plans cover a wide range of day care treatments.

  • ✔️What is the importance of including day care treatment in health insurance?

    The importance of including day care treatment in health insurance are:

    • Quality healthcare services

    • Tax benefits

    • Cashless claims

    • Peace of mind

  • ✔️What factors should you consider when choosing a day care plan in your health insurance cover?

    1. in your health insurance cover?

    Consider the following factors when buying a day care plan:

    • Copayment

    • Sub-limit

    • Age limit

    • Cashless claim facility

  • ✔️What is covered under OPD treatment?

    Under OPD treatment, the patient does not have to get hospitalised. The following expenses are covered under OPD treatment:

    • OPD treatment expense

    • Sum assured up to limited amount is offered

    • Expenses for seasonal illness and general medical check-ups are covered

    • The plan also covers minor injuries that can be treatment in OPD

  • ✔️Is there any day care procedure for COVID-19?

    As per the contemporary scenario, day care treatment cover is not a part of Covid-19 health insurance plans.

     

  • ✔️Is day care treatment covered in group health insurance?

    Yes. Most health insurance providers offer cover for day care procedures for group health insurance plans. However, it depends on the insurer.

     

  • ✔️What is a day care service in a hospital?

    The cover of day care treatment in health insurance refers to the expenses of medical treatments that do not include hospitalisation. Certain illnesses and medical conditions are treated within 24 hours like a cataract operation, chemotherapy or radiotherapy for cancer, sinus aspiration, etc. So, the medical cost of such treatments is covered under day care procedures.

     

  • ✔️What age is best for day care procedures?

    Day care treatment cover should be purchased for anyone who needs frequent visits to the doctor or has certain health conditions. For instance, if you are planning for cataract treatment in the future, you may want to include this cover in your current health insurance cover. On the other hand, an infant or a new mother may also require day care treatment as they may have to frequently visit the doctor. So, irrespective of age, you may require day care treatment in health insurance.

     

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