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 |
|
Nose & Sinus |
|
Ear |
Stapedotomy
Stapedectomy
Auditory ossicle operations
Tympanoplasty
Middle ear operations
Middle ear reconstruction
Inner ear incision
Other operations related to the inner ear
|
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:
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
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?
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:
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.
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.
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.
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.
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.
.jpg)
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.
Getting a loan to take care of my wedding and relieving my parents to enjoy the occasion was the best decision I ever made. Easy-to-apply, amazing interest rate and quick disbursal, what more can one ask for!