Thanks to medical advancements, many treatments that required hospitalisation now take just a few hours, allowing patients to go home within 24 hours. This is where daycare treatment in health insurance comes in.

In this article, we’ll break down the day care treatment meaning, explain why it’s important, list common day care procedures in health insurance, and guide you on how to claim it, so you know exactly what you’re signing up for.

What is Day Care Treatment in Health Insurance?

Day care treatment refers to any medical procedure or surgery that requires hospital admission but lasts for less than 24 hours due to improved medical technology and faster recovery times.

Earlier, health insurance policies only covered procedures that required at least 24 hours of hospitalisation. This left many patients paying out of pocket for shorter treatments like cataract surgery, chemotherapy, or dialysis. With day care procedures covered in health insurance, you’re protected even if your hospital stay is just a matter of hours.

List of Treatments Included in Day Care Procedures

While the exact day care treatment list varies between insurers, some of the most common procedures covered in India include:

• Cataract Surgery: One of the most common day care treatments, cataract removal is a quick procedure that restores vision, often within hours.
• Tonsillectomy: Surgical removal of tonsils, usually performed under general anaesthesia, but patients can go home the same day.
• Dialysis: For kidney patients, dialysis is a life-saving procedure that is typically done on an outpatient basis, but still qualifies as a day care treatment in health insurance.
• Chemotherapy: Cancer treatments like chemotherapy can be administered in a hospital within a few hours.
• Hernia Repair: Certain hernia surgeries can be completed in under 24 hours.
• Endoscopy and Colonoscopy: Diagnostic and minor surgical endoscopic procedures often fall under the day care treatment meaning.
• ENT surgeries: These include septoplasty, eardrum repair, or other ear, nose, and throat-related surgeries.
• Minor Orthopaedic Procedures: Such as arthroscopy or fracture fixation.

Always check your insurer’s list because coverage varies from policy to policy.

What is the Importance of Day Care Coverage in Insurance?

• Comprehensive Coverage for Short-Term Procedures: You’re covered for modern treatments that don’t require long hospital stays, meaning you don’t miss out on claims just because you recover quickly.
• Reduced Financial Burden: Even a few hours in a hospital can cost thousands. Day care coverage ensures these costs don’t come entirely out of your pocket.
• Access to Advanced Medical Treatments: With coverage, you can opt for better hospitals and advanced technology without worrying about affordability.
• Faster Recovery Time: Shorter hospital stays mean you recover in the comfort of your home, with insurance covering the medical part of the journey.
• Flexibility in Treatment Options: You can choose from a wider range of medical facilities and specialists without cost being the primary concern.

What is Covered in Day Care Coverage Plan?

Day care coverage differs, depending on the insurers, but here are the most common ones covered:

• Medical expenses for listed daycare procedures in health insurance.
• Doctor’s fees, surgeon’s fees, and anaesthetist charges.
• Operating theatre charges.
• Pre- and post-hospitalisation expenses (as per policy terms).
• Cost of prescribed medicines and diagnostic tests related to the procedure.

What is Not Covered in Day Care Coverage Plan?

Typically, insurers do not cover:

• OPD consultations without hospital admission.
• Experimental or unproven treatments.
• Non-medical expenses like registration fees, consumables, or convenience charges.
• Procedures that are done purely for cosmetic purposes.

How to Claim Day Care Treatment?

There are two main ways to claim your day care treatment costs:

1. Cashless Claim Process

   • Choose a network hospital of your insurer.
   • Inform your insurer before the procedure (for planned treatments) or within 24 hours (for emergencies).
   • Provide your health card and ID proof at the hospital.
   • Then, the hospital will send treatment details to the insurer for approval.
   • Once approved, you can get treated without paying upfront (except non-medical expenses).

2. Reimbursement Process

   • Get treated at any hospital of your choice.
   • Pay the bills yourself at the time of discharge.
   • Submit all documents, bills, and reports to your insurer.
   • The insurer processes your claim and reimburses the approved amount.

What’s the Difference Between Day Care and OPD?

While both can involve short treatments, they’re not the same. A day care treatment is when you’re admitted for less than 24 hours but require hospital-based procedures. OPD covers treatments that don’t need hospital admission at all.

Day Care vs OPD Treatments

Factors to Consider When Buying a Day Care Coverage Plan

• Procedures Covered: Check the day care treatment list carefully. Read what’s covered in your plan and what is excluded, as each plan has different coverage.
• Claim Settlement Process: Look for insurers with high claim settlement ratios.
• Waiting Period: Some procedures may have a waiting period before coverage starts.
• Co-Payment and Sub-limits: Understand how much you’ll have to bear yourself.
• Sum Insured: Choose a coverage amount that suits your healthcare needs.
• Premium Costs: Balance affordability with comprehensive benefits.
• Add-on Covers: Look for add-ons like OPD cover for complete protection.
• Reputation and Support Services: Good customer service can make a big difference during claims.

FAQs:

1. What is the meaning of day care expenses?

   It refers to costs for medical procedures that require hospitalisation for less than 24 hours.

2. What is OPD treatment in health insurance?

   OPD covers consultations, diagnostics, and medicines without hospital admission.

3. How is day care treatment different from regular hospitalisation?

   Regular hospitalisation requires a stay of more than 24 hours, while a day care treatment does not.

4. How can I find out if my health insurance policy covers a specific day care treatment?

   Check your policy document for the list of treatments covered or contact your insurer for the same.

5. Are there any specific criteria for a procedure to be considered as day care treatment?

   Yes, it must require hospital admission, but be completed in under 24 hours.

6. Is pre-authorisation required for day care treatments under health insurance?

   Most insurers require pre-authorisation for planned procedures.

7. Are there any limitations on the number of day care treatments covered in a policy year?

   The limitation on this number depends on your insurer and policy terms.

8. Will I have to pay any out-of-pocket expenses for day care treatment under health insurance?

   You might have to pay for non-medical costs or amounts beyond policy limits. Check with your insurer for the same.