What is a Day Care Treatment?

A day care procedure is a medical procedure, where patients are discharged within 24 hours, or within a day. Because of advancements in medical science, many medical procedures requiring prolonged hospitalization, can now be easily completed within hours. These medical procedures come under the ambit of day care treatment.

 

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 that need you to get 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, and other doctor advises are covered under OPD benefits.

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 to 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 anesthetists 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/theater charges etc. is also covered under the day care treatment.

Exclusions in Day Care Treatment Facility

  • There can be certain medical procedures that are not covered under day care treatment. Usually, day care procedures don’t cover cosmetic surgeries. Unless such a surgery is required to save the life of the policyholder, cosmetic surgery will be in 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.

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 which includes day care treatment. 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 for providing state-of-the-art medical services.

  • Cashless claims

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

  • Tax benefits

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

  • Health CDC benefit

Also known as Click by Direct Claim (CDC), this is a key highlight of Health Insurance, available on Finserv MARKETS. This unique app-based feature allows you to raise and settle claims, up to Rs 20,000, in a convenient and hassle-free manner. Here, you have to use the Insurance Wallet app to make claims. Once you provide the requisite details, including discharge date, estimate of expenses and details about diagnosis and treatment, the claim amount will be shortly transferred in 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 empaneled network hospital, along with the financial assistance ensures that you receive any day care procedure with zero worries, and complete peace of mind.

Difference Between Day Care Treatment and OPD

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

 

Day Care Treatment

OPD Cover/Benefit

Definition

Day care treatment meaning refers to the medical treatments that need hospitalisation for less than 24 hours due to advancements in medical technology.

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 towards the concerned day care treatment.

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

 

Filing a Claim for Day Care Treatment

The process to raise claims on daycare procedures is the same as raising claim requests on your health insurance policy. Your insurer will process the day care treatment claim as a part of your health insurance cover. Besides, note that a GST rate of 18% applies to all financial services, effective from July 1, 2017.

Things to Keep in Mind Before Availing 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 daycare procedures covered under the policy. Go through the fine prints 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 requisite documents, while filing a claim, it can result in rejection.

  • The claim process for day care treatment is similar to your health insurance claim process. So, you must always proceed in a time-bound fashion. Along with timely submission of claims, don’t forget to inform the insurance company, a few days in advance, before undergoing any planned day care procedure.

Conclusion

The medical procedures, which would earlier require continuous hospitalization, can now be easily completed within a day. In sync with the rapidly evolving medical science technology, insurance companies have provided for day care procedures. Now day care procedures cover a wide slew of medical procedures, like surgeries of eyes, nose and ears along with orthopaedic and oncological procedures.

A widespread myth among people is that health insurance companies only provide for medical treatment, which requires a longer period of medical treatment. This is, however, false. Health insurance policies have now been adopted to include short-term hospitalization procedures. You can zero in on the various Health Insurance policies, available on Finserv MARKETS to get access to the ideal plans that open up better healthcare options.

Best Health Insurance Plans Available at Finserv MARKETS

FAQs On Day Care Treatments

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

    No. Daycare 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 plan covers a wide range of daycare procedures for extensive coverage.

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

    The importance of including daycare procedures in health insurance is better understood with its benefits. These include:

    • Quality healthcare services
    • Tax benefits
    • Cashless claims
    • Peace of mind
  • ✔️What factors should you consider when choosing a daycare plan in your health insurance cover?

    Consider the following factors when buying a daycare plan –

    • Copayment
    • Sub-limit
    • Age limit
    • Cashless claim facility

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