Day Care Treatments Covered Under Health Insurance

What are Day Care Procedures in Health Insurance?

In health insurance, "Day Care Procedures" refer to medical treatments or surgeries that require hospitalization for not more than 24 hours due to advanced medical technologies. These procedures are often covered under health insurance policies, even though they do not require the traditional 24-hour hospitalization.

A few of the common examples of such treatments include cataract, radiotherapy, chemotherapy, dialysis, angiography, tonsillectomy, lithotripsy, etc. Some health insurance companies in India cover limited day care procedures, while others may cover all day care treatments. The list of all the day care procedures covered is given in the insurance policy documents and can also be found on the insurance company's website.

Day Care Treatment Procedures Covered Under Health Insurance

Following are the different types of treatments included in day care procedures:

* This is just an illustrative list. For detailed information on day care coverage, please refer to the policy document.

Health Insurance Plans Covering Day Care Procedures

Take a look at the list of health insurance plans that cover day care procedures in India:

*Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. This list of plans listed here comprise of insurance products offered by all the insurance partners of Policybazaar. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in.

How Does Day Care Health Insurance Works?

Despite the fact that most day care procedures do not require hospitalization of 24-hours or more, they can still be expensive. Even over-the-counter expenses like diagnosis tests can cost a bomb. This is where day care health insurance saves the day.

Let us understand the working of day care health policy with the help of an example:

Mr. Verma was diagnosed with kidney stones and a specialist advised lithotripsy for the stones' removal. Earlier, the patient needed to be hospitalized to undergo this surgery. But due to medical advancements, this surgical procedure can now be completed in few hours and the patient gets discharged on the same day.

Mr. Verma holds a health insurance policy that covers day care medical procedures. He scheduled the surgery for a later date and took the necessary steps to avail cashless services. The cashless payment procedure was smooth and Mr. Verma's health insurance provider approved the treatment costs without any hassles, as lithotripsy was covered under the insurance company's listed day care procedures.

Advantages of Day Care Health Insurance

Day care health insurance offers several advantages, a few of which are mentioned below:

• Covers Short-duration Treatments: It provides coverage for medical procedures that do not require a 24-hour hospital stay, such as cataract surgery, chemotherapy, and dialysis.
• Reduces Financial Burden: Day care health insurance covers even minor but costly treatments, reducing out-of-pocket expenses.
• Wide Coverage: Many insurance plans include a broad list of day care procedures, ensuring extensive protection.

How to Choose a Day Care Health Insurance Plan?

Most health insurance companies highlight the “number” of day care procedures covered under their policy to entice customers. As a result, novice health insurance buyers wrongly choose a mediclaim policy with maximum day care procedures.

However, the number of day care procedures listed in the medical insurance plans is not the only factor that one must consider before investing. Cashless facility, age limit, sub limit, co-pay, etc. all play an important role while selecting health insurance policy.

1. Quality vs. Quantity

   It is advisable to see the treatments covered under the day care procedures in a broader 'concept' sense. For instance, instead of looking at the number of day care procedures covered, looking at categories like urology, oncology, etc.is a more practical, beneficial and inclusive approach, as hundreds of procedures are covered under these broad umbrellas.

2. Sum Insured

   Choose a health policy whose sum insured matches potential costs for day care procedures, keeping in mind inflation and medical advancements.

   You must consider opting for a higher sum insured for better coverage.

3. Inclusions & Exclusions

   While buying a day care Mediclaim policy, make sure that the chosen plan includes common and likely procedures. In fact, do not forget to check the policy for treatments or procedures that are not covered.

4. Co-payment Clause

   Ensure you check the co-payment clause so that you can be prepared beforehand to pay a certain percentage of the health insurance claim amount while the insurer covers the rest. Always try to choose a plan with minimal or no co-payment.

Process of Filing Day Care Claims in Health Insurance

The process for filing day care claims is similar to that of a regular health insurance policy, since day care procedure coverage is an in-built policy feature. In case of planned procedures, the cashless route can be availed but in that case some companies need prior intimation.

In other cases, insurers reimburse the expenses incurred after submission of the required documents. The provisions for pre and post-hospitalization benefits also remain the same.

In fact, with the “Cashless Everywhere” initiative, you can now avail cashless treatment at all hospitals in India. This means that even if the treatment is obtained in a non-network hospital, you can still benefit from cashless facility.

Outpatient Department (OPD), Dental and Maternity Covers

Some insurance companies offer policies where the USP is the coverage of outpatient department (OPD), maternity, and dental expenses. These policies cover treatments not requiring 24-hour hospitalization nor forming a part of the day care procedures list.

The primary difference between OPD cover and day care procedures is the nature of the procedures covered. While OPD cover includes minor healthcare expenses, the latter relates to expensive procedures that otherwise would have entailed at least 24-hour hospitalization, if not done using medical technology advancements. For example, dental treatments fall under the OPD category, whereas cataract surgery comes under the category of day care procedures.

Now it's Your Turn!

Amid the growing medical inflation, coverage for day care procedures in health insurance is imperative in reducing the unnecessary financial burden. So do your research well to opt for a health insurance company that covers a broad range of day care treatments.