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Day care treatment and procedures covered under health insurance

Team AckoAug 5, 2021

Health insurance plans have become necessary nowadays to manage high-cost healthcare procedures. Most health insurance providers offer coverage for extended hospital stays and major treatments or surgeries. However, many treatments don’t require an extended hospital stay, but still end up draining patients’ finances. Thankfully, day care treatment procedures that need less than 24 hours are now also covered under many health insurance policies. 

However, not every insurance company covers all day care procedures. Therefore, you should definitely check what types of day care treatments a policy covers before buying.

Day Care Treatment Procedures Covered Under Health Insurance

What is a day care treatment procedure?

A day care treatment procedure involves medical operations, treatments and surgeries that require less than 24-hour hospitalisation. Few examples of day care procedures are cancer chemotherapy, appendectomy, angiography, radiotherapy and more.

A day care procedure refers only to those medical surgeries, operations or treatments that require not more than 24 hours of hospitalisation due to modern medical technology. Therefore, OPD consultations related to sprains, fractures, and other smaller procedures should not be confused as day care treatments. 

What are all day care treatment procedures covered under health insurance?

Generally, all health insurance policies include day care coverage. However, the list of day care procedures may change from one insurer to another. Here are some of the commonly covered procedures. 

List of day care treatment procedures under health insurance:

Treatment Operations/Procedures
Eyes Cataract
Throat Adenoidectomy
Gastro Appendectomy
Rectal Piles/fistula
Nose Septoplasty
Others Angiography, Chemotherapy, Radiotherapy

Please note that this is only an illustrative list. You may go through the policy document for detailed information on day care coverage. 

Importance of buying Day Care coverage in health insurance

Having day care treatments covered under health insurance provides you with much-needed financial support for procedures that need less than 24-hour hospitalisation but cost a lot.

  • Convenient healthcare: Day care procedure coverage allows access to high-quality medical care without having to worry about treatment expenses.

  • Straightforward claim process: A policyholder can utilise a reimbursement or cashless claim method based on the hospital selected and terms of the policy.

  • Wide healthcare network: Policyholders get access to a vast network of healthcare providers, which makes timely and quality healthcare available.

  • Tax savings: A health insurance policy allows policyholders to attain tax benefits based on the amount paid as the insurance premium. 

Day care treatment: What is covered?

Day care treatments coverage in health insurance offers medical expenses associated with any surgery, treatment, or operation that requires the policyholder to spend less than 24 hours in a hospital. Some good examples of day care treatments include eye surgery, dialysis, chemotherapy, and any illness or injury that requires you to spend only a few hours at a day care centre.

What is not covered under day care treatment?

A day care treatment under health insurance doesn’t cover you for all short-term medical procedures. Treatments managed by the Outpatient Department (OPD) are not considered as day care procedures.

For example, medical consultation for minor injuries, seasonal illness, and regular consultations are considered under OPD. Such procedures don’t require any major surgery, hence are not covered as day care treatments.  

What makes a medical treatment eligible as a day care procedure?

The eligibility of medical treatment under day care procedure cover comes down to three factors.

  • The procedure/treatment has to be medically necessary.

  • The procedure/treatment should require the patient to be admitted to a hospital.

  • The procedure/treatment should require less than 24 hours because of advanced medical technology. 

How to file a claim for day care procedure?

The process of filing a claim for a day care procedure is similar to an inpatient treatment claim. You can choose a cashless or reimbursement claim settlement method based on the type of hospital selected for a day care treatment. 

Cashless claim via network hospitalisation:

Step 1 - Choose a network hospital for your day care procedure and inform the insurer before your hospitalisation.

Step 2 - The insurer will receive the same information from the hospital confirming that the treatment comes within the terms and conditions of a day care procedure cover.

Step 3 - The hospital will receive all medical payments from the insurance company based on the terms of your day care procedure cover.

Reimbursement claim via non-network hospitalisation:

Step 1 - Choose any non-network hospital and inform the insurer before your hospitalisation.

Step 2 - Pay all the treatment-related costs from your pocket.

Step 3 - Submit all soft copies of relevant documents to raise a reimbursement claim.

Difference between a Day Care treatment and OPD treatment cover

There are several nuanced differences between a day care procedure and OPD treatment cover.

Factors Day Care Treatment OPD Treatment
Hospitalisation Less than 24-hour hospitalisation is compulsory Hospitalisation is not required
Extent of coverage To the extent of total sum insured Coverage up to a limited sum based on the insurer.
Examples of procedures Cataract surgery, angiography, chemotherapy, etc. General medical consultation for seasonal illness, health checkups, minor injury etc.

Things to consider while buying Day Care health insurance coverage

Having day care procedures included in your health insurance can save you from the financial burden of medical operations/surgeries that don’t require any longer than a 24-hour hospitalisation. However, you should consider a couple of factors to maximise the benefits as a policyholder.

  • Total sum insured: Ensure that the total sum insured will be enough to meet your day care treatment requirements.

  • Included and excluded treatments: Carefully read the policy document to understand what treatments are included and what treatments are excluded from the day care procedure as per your insurance provider.

  • List of network hospitals: Go through the list of network hospitals to shortlist all nearby hospitals to conveniently avail the cashless claim facility. 

Frequently asked questions

Do I need to purchase day care coverage as an add-on with my health insurance?

Not at all. You don’t have to opt for day care treatment coverage separately. It comes included in the health insurance as a feature, depending on the terms of the policy.

Which day care treatments are covered under a health insurance plan?

The list of day care treatments changes from insurer to insurer. Hence, you should read the policy document carefully to understand what all procedures are accepted as day care treatments.

Is there a limit to the claim amount for a day care procedure?

Day care treatments in a health insurance plan are usually covered up to the total sum insured.

Can senior citizens get coverage for day care treatments?

Yes, senior citizens also get coverage for day care procedures in health insurance.

What comes under OPD treatment?

An OPD or Out-patient Department treatment involves general health consultations and minor treatments related to fractures, stitches etc.

Is there any day care treatment for the COVID-19?

As of now, treatments for COVID-19 do not include any day care procedures.

Are day care treatment procedures covered under Group Health Insurance?

Yes, day care treatment procedures are also covered under Group Health Insurance. However, you should check with the insurance provider to understand what procedures are included in the respective policy.

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