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What is a Day Care Treatment?

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.  

However, cosmetic day care treatments and procedures like dental cleaning are usually not covered unless they are performed to save the life of the policyholder. The maximum coverage for day care treatment is limited to the sum insured under the policy. 

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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 daycare 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.

Which Day Care Treatment Procedures are Covered Under Health Insurance?

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

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.

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 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.

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 daycare 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 daycare 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 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.

Difference Between Day Care Treatment and OPD

As stated earlier, people tend to get confused between OPD cover and daycare 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. 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.

Conclusion

Medical procedures that earlier required continuous hospitalisation, can now be easily completed within a day. In sync with the rapidly evolving medical technology, insurance companies have provided coverage for day care procedures. A widespread myth among people is that health insurance companies only provide for medical treatments, which requires a longer period of hospitalisation. This is, however, false. Health insurance policies have now been adopted to include short-term hospitalisation procedures as well. You can zero in on the various health insurance policies available on Bajaj Markets to get access to the ideal plans that open up better healthcare options.

Best Health Insurance Plans Available at Bajaj Markets

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 procedures.

     

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

    The importance of including day care procedures 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?

    Consider the following factors when buying a day care plan:

     

    • Copayment

    • Sub-limit

    • Age limit

    • Cashless claim facility

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