Advancements in medical science and technology have reduced the time required to complete a medical procedure and to recover. Many complicated procedures like cataract surgery, angioplasty, kidney stone removal, etc. can now be performed in a few hours allowing the patient to be discharged on the same day. Such procedures are not only cost-effective because hospitalisation is not required but also allow the patients to recover in the comfort of their homes. In health insurance terminology, such procedures are termed as Day Care procedures and are now covered by most health insurers.
Did you know Care health insurance also provides coverage for all day care procedures through their wide range of health insurance plans? Let’s explore!
What is a Day Care Treatment in Health Insurance?
Treatments or procedures that can be conducted within a day and require less than 24 hours of hospitalisation are called day care treatments. Initially, such treatments were not covered under health insurance and only hospitalisation of at least 24 hours was covered. But with evolving technology and changing healthcare industry, any medically necessary day care treatment prescribed by a doctor is now covered in a health insurance plan. IRDAI has directed insurance companies to include a list of day care treatments covered in their health insurance plans so that customers can make an informed decision. Some common treatments covered under Care health insurance plans are;
- Heart: Angiography
- Eyes: Cataract surgery, foreign body removal, corrective surgeries
- ENT: Septoplasty, Tonsillectomy, Nasal Sinus Aspiration, Tympanoplasty, operations of the middle and inner ear
- Tongue: Reconstruction of tongue and other surgeries
- Cancer Treatment: Chemotherapy, Radiotherapy
- Other procedures: Dialysis, Colonoscopy, Lesion removal, Piles, Hydrocele, Sclerotherapy, Appendicectomy, Thoracoscopy, Skin operations, dental surgery for injuries, etc.
Benefits of Buying Day Care Treatment Coverage
The importance of day care treatments in health insurance coverage can be understood with the help of the benefits offered by day care health insurance coverage.
Financial Protection
Since day care treatments are advanced procedures using modern technology, they are expensive treatments even if no hospitalisation is needed. Hence having day care treatment coverage protects you against the expenses incurred in day care treatments.
Cashless Treatments
Health insurance coverage for day care treatments allows you to avail of cashless treatment at network hospitals because most of these advanced procedures have to be planned.
Convenient
Coverage for day care treatments allows the policyholder to access quality healthcare and focus on recovery.
Easy Claim Settlement
Since these treatments are pre-planned, the policyholder can opt for cashless treatment making the claim settlement process fast and easy. The claim process is the same as that for hospitalisation.
Tax Saving
A policyholder can enjoy tax benefits on the premium paid for health insurance coverage including day care treatments. Under section 80D of the Income Tax Act, the premium paid for health insurance is eligible for tax deduction.
Things to Consider while Buying a Day Care Treatment Health Insurance
Now that you know the benefits of having a day care health insurance plan, here are some important points to consider while buying a health insurance plan.
Quality over Quantity
Always check the list of day care treatments covered under a health insurance plan. Ensure that it has the treatments that you and your family might need in future. Hence instead of focusing on the number of treatments covered, check whether your preferred treatments are covered or not.
Look for Categories
Instead of having 20 different types of day care treatments, always prefer a plan that specifies broader categories of treatments such as urology, oncology, ENT, etc. because it is easier to get a procedure covered in a specified category.
Network Hospitals
Always check the network of hospitals and make sure that your preferred hospitals are included in the network. It is often convenient to have nearby hospitals in the network so that you can easily get cashless settlements.
Type of Policy
Always select a comprehensive health insurance policy for broader coverage including coverage for day care treatments.
Day Care Treatment Vs OPD Treatment
People often mistake treatments taken at an OPD as day care treatment but it is different from a day care treatment.
| Day Care Treatment |
OPD Treatment |
| A treatment is considered a day care treatment only when the patient is hospitalised to undergo the treatment. However, the hospitalisation is less than 24 hours |
Hospitalisation is not required and treatment is done at doctor’s OPD, room or clinic |
| Day care treatments are generally covered up to the sum insured |
OPD treatments are covered up to the limit specified in the policy |
| Cataract surgery, chemotherapy, dialysis etc. are day care treatments. |
Dressing a wound, casting a plaster etc. are OPD treatments. |
| Most of the health insurance providers offer day care treatment |
Only a few providers offer OPD cover |
How to File a Claim under Day Care Treatments?
The claim process for day care treatments is similar to any health insurance claim process. Since most day care procedures are pre-planned you can avail treatment at a network hospital and get a cashless settlement. Inform the insurance company before hospitalisation regarding the claim.
For cashless claims, go to the insurer’s desk at the network hospital, fill out a pre-authorisation form, and provide your health card and ID proof. Once your claim request is approved your hospital bills will be directly settled by the insurance company.
For reimbursement claims, the insured needs to provide all the necessary documents along with a doctor’s prescription advising the day care treatment.
>> Also Read: Comprehensive Guide to Day Care Treatment, Coverage and Advantages
A Piece of Advice!
To ensure the right policy you must explore the options, compare the plans basis on the parameters such as coverage, features, waiting period, claim settlement ratio etc. When you are looking for day care treatment health insurance, always check the inclusions and exclusions under the plan. Get a plan that offers coverage for a broad range of day care procedures. At Care Health Insurance, you get extensive coverage that can be customised for your requirements. For more detail visit our website or allow the experts to connect with you.
Disclaimers: The above information is for reference purposes only: Policy Assurance and Claims at the underwriter’s discretion.
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