Are you curious to know about the procedures that are covered in Day Care Treatment Health Insurance? Let us know more about the Day Care Treatment List.

With the advent of medical advancement, several medical procedures that were once considered complicated are now being easily treated. Several medical treatments and surgeries do not require 24-hour hospitalisation so the patient is discharged the same day. These procedures come under Day Care Treatment. Most of the health insurance policies cover Day Care Treatment. If the medical treatment performed on an individual comes under the Day Care Treatment list in the health insurance policy, then the person can file a claim for the Day Care procedure.

What Does Day Care Treatment Mean?

Let us understand the concept of Day Care Treatment better with an example.

For example, Mr Ben is admitted to the hospital for Cataract Surgery. Within few hours of surgery, he is discharged from the hospital the same day. Mr Ben is worried about being discharged as he remembered that he won’t be able to get the claim from the insurance company since the claim can be made only if he is hospitalised for a minimum of 24 hours. The doctor explained to him that due to medical advancement certain medical procedures do not require hospitalisation and can be treated the same day. Such a type of procedure is called Day Care Treatment. Health insurance policies cover such Day Care Treatment. Mr Ben was relieved to know that his medical surgery is covered under his health insurance that comes under the Day Care Treatment List.

Day Care Treatment List:

While buying a health insurance policy make sure to look out for the Day Care Treatment list as these may vary from policy to policy. Let us take a look at the list of Day Care Treatment that is covered in the health insurance policy.

1. Cancer Treatment:

  1. Chemotherapy
    • Radiotherapy

2. Heart Surgery:

  • Coronary Angiography

3. Kidney Surgery:

  1. Haemodialysis
    • Lithotripsy

4. Eye Surgeries:

  1. Cataract Surgery
    • Corneal Incision
    • Foreign body removal
    • Tear duct surgery
    • Corrective entropion and ectropion surgery
    • Eyelid Incision

5. Ear Surgeries:

  1. Stapedotomy
    • Tympanoplasty
    • Stapedectomy
    • Middle ear surgery
    • Auditory ossicles surgery
    • Middle Ear reconstruction
    • Incision of the inner ear

6. Nose Surgery:

  1. Removal of foreign body in the nose
    • Nasal concha surgery
    • Nasal sinus surgery

7. Tongue:

  1. Glossectomy
    • Tongue reconstruction

8. Skin:

  1. Skin Transplant
    • Chemosurgery to skin
    • Incision and Excision procedure on skin.
    • Plastic surgery

9. Bones:

  1. Dislocation surgery
    • Ligament and meniscus tear surgery
    • Joint and bone surgeries
    • Trauma surgery
    • Tendon fracture and sutures

10. Other Surgeries:

  1. Hydrocele
    • Colonoscopy[
    • Appendectomy
    • Fistula
    • Sclerotherapy
    • Liver aspiration
    • Thoracoscopy
    • Dental surgeries due to certain injury
    • Tonsillectomy
    • Myringotomy

Insurance Companies Offering  Day Care Treatment and the Treatments Covered:

  1. Star Health Insurance Family Health Optima covers almost 170 Day Care Treatments.
  2. HDFC ERGO Health Insurance covers all the Day Care Treatment costs.
  3. TATA AIG Health Insurance covers almost more than 500Day Care Treatment costs.
  4. MAX Bupa Health Insurance Heart Beat Plan covers almost more than 400Day Care Treatment costs.
  5. ICIC Health Insurance covers almost 136Day Care Treatment costs.
  6. BAJAJ ALLIANZ Health Guard Policy covers almost 130Day Care Treatment costs.
  7. Apollo Munich Optima Restore covers all the Day Care Treatment costs.
  8. Apollo Munich Easy Health covers almost 144Day Care Treatment costs.
  9. National Parivar Mediclaim  Plus Health Insurance covers almost 140Day Care Treatment costs.
  10. New India’s Family Floater Mediclaim Plus covers all the Day Care Treatment costs.

Benefits:

If you opt for health insurance with day care procedures several benefits can be availed.

  • The best quality medical treatment for daycare procedures can be availed from the medical network hospital. The insurance companies have a network of more than 6500+ hospitals that provide the best medical care treatment for you and your family members, even if the hospitalisation is for less than 24 hours.
  • Go Cashless for the day care procedures covered under your health insurance policy. To avail of this benefit, you have to inform the insurance company in advance and get approval to avail of day care medical treatment without paying any cash. The hospital bills will be directly paid by the insurer.
  • Avail Tax benefits for the health insurance day care procedures. Health insurance offers a tax deduction benefit on paying the premium for your policy as per Section 80D of the Income Tax Act 1961.
  • It saves you from financial loss. Although Day care procedures do not require 24-hour hospitalisation the treatment cost is expensive. By opting for health insurance with day care treatment the policy covers the treatment expense thus saving you financially.
  • The claim procedure is easy and simple.

How to File a Claim for Day Care Treatment?

Since the day care procedure is a part of health insurance the procedure for filing a claim is carried in the same manner as health insurance. In case of a pre-determined procedure, the insured can avail of the cashless facility by intimating the insurance company in advance and get approval from the insurer.

Or if the insured wishes for reimbursement then after submitting the required documents the insurer will reimburse the money back to the insured. Pre and post hospitalisation procedure is also the same. After the claim has been made the insurer will reimburse the pre and post hospitalisation expenses.

How to Choose a Suitable Day Care Treatment Health Insurance Policy:

There are certain points that one needs to remember while purchasing a health insurance plan.

  • Considering the medical inflation and expensive treatments make sure to opt for a health insurance coverage with sum insured that will meet your healthcare needs.
  • Do not get carried away by the long list of day care procedures available in the policy plan. Read through the policy thoroughly and analyse if the benefits offered in the policy plan meets your requirements.
  • Choose the best type of policy that suits your requirements like an individual policy or family floater policy that has all the comprehensive medical coverage including the day care treatment.
  • Read the policy document carefully as they may include a certain clause in the policy. Sometimes the policy has a co-payment clause wherein the policyholder has to bear a certain percentage of treatment expenses. Some policies specify certain cases where the policyholder is not eligible to get the claim.
  • Go through the list of network hospitals provided by the insurers and make sure the network hospital is nearer to your location in case of medical emergencies.

Outpatient Department (OPD):

Most people tend to confuse OPD and day care procedures. OPD included minor expenses while consulting a doctor for small treatments like dental treatment, fractures or stitches. OPD does not require hospitalisation. OPD is also covered in health insurance.

Exclusions:

  • The policy comes with a certain clause where the policyholder can not make a claim.
  • Certain medical treatments are not covered under day care procedures. For example, cosmetic surgery does not come under day care procedures and cannot be claimed. If the cosmetic surgery is done to save the life of a policyholder the exclusion is made.
  • Any OPD treatments cannot come under day care procedures and cannot be claimed. The expense for any medical treatment that comes under OPD will not be reimbursed. So make sure that your policy covers OPD in the health insurance.

Factors to be Considered While Purchasing:

  • The type of policy you choose.
  • Your age limit.
  • The amount of the sum insured or the policy coverage.
  • The terms and conditions of the day care treatment health insurance.
  • Co-payment clause in the policy.
  • The number of members included.
  • Choose a policy with broadly categorised treatments.

To Sum Up!

We strongly recommend that you read the policy document carefully before purchasing health insurance. It is best to seek advice from health insurance experts who can guide you and give you a better understanding of the different policies available. It is always a good practice to discuss with your insurance agent about the inclusions and exclusions in the policy and fully understand the limitations and benefits of the policy to avoid confusion and trouble while filing a claim for the day care treatment health insurance. Purchase health insurance with a broad category of day care treatments and get secured financially.

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Prateek Mahesh

Prateek has 17+ years of experience writing in Investment Strategy and Sales for Life Insurance. He has done MBA in Insurance and Investment.

Their aim is to educate people on various insurance topics so that they can make wise decisions.

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