What is Daycare Treatment in Health Insurance?

Understand the concept of daycare treatment in health insurance and learn about the benefits and claim process.
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What is Daycare Treatment in Health Insurance?
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3 mins
02 January 2024

When it comes to health insurance, most people think about coverage for hospitalisation and major medical procedures. However, not many are aware that many health insurance plans also cover daycare treatments. This article will help you understand what daycare treatments are and why it is important to have coverage for them in your health insurance plan.

What is a daycare treatment?

Daycare treatment in health insurance refers to medical procedures or surgeries that do not require an overnight stay at the hospital. These are swift interventions, typically completed within a few hours, allowing patients to return home on the same day. Daycare treatments have revolutionised healthcare, providing efficient and cost-effective alternatives to traditional inpatient care.

Which treatments are included in daycare procedures?

Daycare procedures cover a spectrum of medical interventions. Common treatments include:

  • Minor surgeries: Such as cataract surgery, tonsillectomy, and hernia repair.
  • Diagnostic tests: Like endoscopy, colonoscopy, and certain imaging procedures.
  • Chemotherapy and dialysis: Sessions that are completed within a day.
  • Infusion therapies: Administered in a controlled environment for various medical conditions.

Which insurance companies offer coverage for daycare procedures?

Several insurance providers in India recognise the importance of daycare treatment coverage. Some notable names include:

Note: The number of daycare procedures in health insurance may vary according to the health insurance plan/variant chosen.

Benefits of having coverage for daycare treatment in health insurance

Know the advantages of having coverage for daycare treatment in a health insurance plan.

Cost efficiency: Covers high medical expenses incurred during daycare treatments. This reduces the financial burden on policyholders for swift medical interventions.

Comprehensive coverage: Ensures a holistic health insurance policy by including both inpatient and daycare treatments. Addresses a wide range of medical procedures, providing a well-rounded coverage.

Quick recovery: Facilitates prompt medical interventions without the need for extended hospital stays. This enables policyholders to resume their daily routines swiftly.

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Choice of network hospitals: Allows policyholders to choose from an extensive network of hospitals for daycare treatments. Enhances accessibility to quality healthcare facilities.

Tips to choose a health insurance plan with coverage for daycare procedures

Here are some factors you must consider when choosing daycare health insurance plans.

Assess your specific needs: Evaluate your medical history and potential requirements for daycare treatments. Choose a plan that aligns with your health needs and preferences.

Check for network hospitals: Check the list of network hospitals associated with the insurance provider. Ensure that reputable hospitals offering daycare services are within your reach.

Claim process transparency: Understand the claim settlement process for daycare treatments. Opt for an insurance provider with a straightforward and transparent claims procedure.

Policy inclusions and exclusions: Scrutinise the policy document to identify inclusions and exclusions related to daycare treatments. Be aware of any waiting periods or conditions attached to the coverage.

You can visit the Bajaj Finance Insurance Mall to compare and choose health insurance plans offering daycare treatment coverage. These plans are specially curated as per the individual needs and offered by the leading health insurance companies in India. The platform enables a 100% digital buy process, helping you buy health insurance plans online without any paperwork.

Here are some of the top health insurance plans available at the Bajaj Finance Insurance Mall with the number of daycare procedures covered:

Plan

Daycare procedures covered

Know more

Aditya Birla Group Activ Health

527

Check the plan

Bajaj Allianz Health Guard

399

Check the plan

Niva Bupa Health Plus

536

Check the plan

Aditya Birla Activ Assure Diamond

586

Check the plan

 

What is covered and not covered in day care treatment in health insurance?

Given below are the common inclusions and exclusions under daycare treatment in health insurance:

Day care treatment coverage:

  • Day care treatments, which require hospitalisation for less than 24 hours, are typically covered by health insurance.
  • Procedures such as chemotherapy, dialysis, cataract surgery, and minor surgeries are included.
  • Coverage extends to medical expenses incurred during pre- and post-operative care.
  • Diagnostic tests, consultations, and medications related to day care treatments are often covered.

Exclusions from day care treatment coverage:

  • Experimental or investigational procedures may not be covered.
  • Cosmetic surgeries and treatments for aesthetic purposes are typically excluded.
  • Certain dental treatments and alternative therapies may not be covered.
  • Treatments deemed unnecessary or not medically necessary may be excluded from coverage.

Claim process of daycare treatments in health insurance

Here is a quick guide to how you can raise a claim for daycare treatment coverage in health insurance.

Intimation: Inform the insurance provider about the planned daycare treatment in advance.

Document submission: Submit the necessary documents, including medical reports and bills, to the insurer.

Claim verification: The insurance company will assess the submitted documents to verify the authenticity of the claim.

Approval and reimbursement: Upon successful verification, the claim will be approved, and reimbursement will be processed. In case you have opted for daycare treatment at the insurer’s network hospital, the insurer will directly settle the bill with the hospital.

In conclusion, having coverage for daycare treatments in your health insurance plan can provide important financial protection and peace of mind. However, it is important to carefully compare the available plans and choose one that meets your specific needs. With the right coverage, you can focus on your health without worrying about the financial burden of medical expenses.

Difference between a Day Care treatment and OPD treatment cover

Daycare is different from OPD treatment cover in multiple ways. Given below are the differences between the two:

Aspect

Day care treatment cover

OPD treatment cover

Definition

Medical procedures requiring leaa than 24 hours hospitalisation.

Outpatient medical services that do not require hospitalisation.

Coverage

Generally covered by health insurance plans.

Coverage may vary; some plans include limited OPD coverage.

Examples

Chemotherapy, minor surgeries, dialysis, cataract surgery.

Doctor consultations, diagnostic tests, medications.

Duration of stay

Typically less than 24 hours in a hospital or clinic.

No hospitalisation; patients return home same day after treatment.

Pre- and Post-Op Care

Covered by insurance, including consultations and medications.

Consultations, tests, and medications related to diagnosis and treatment.

Exclusions

Experimental procedures, cosmetic surgeries.

Dental treatments, alternative therapies, non-essential treatments.

Insurance Reimbursement

Reimbursed as per policy terms and conditions.

Reimbursed based on policy coverage limits and terms.

Read in detail about the difference between OPD and daycare treatment.

Frequently asked questions

What is day care treatment in health insurance?

Day care treatment is a type of medical treatment that does not require an overnight stay at a hospital. It is usually less invasive, and patients are able to go home on the same day as the procedure. Day care treatment is covered by health insurance, as long as it is included in the policy terms and conditions.

Is day care treatment and OPD same?

No, day care treatment and OPD (outpatient department) are not the same. OPD refers to all medical services and treatments provided to patients who are not admitted to the hospital. Day care treatment, on the other hand, refers specifically to medical procedures that are carried out in a hospital or clinic, but do not require the patient to stay overnight.

What are examples of day care procedures?

Some common examples of day care procedures include cataract surgery, tonsillectomy, appendectomy, breast biopsy, colonoscopy, and chemotherapy. These are all medical procedures that can be completed in a few hours, without requiring an overnight stay at a hospital.

Is fracture covered in day care treatment?

It depends on the type of fracture and the policy terms and conditions. Some fractures may require a longer hospital stay and more intensive medical treatment, which may not be covered under day care treatment. However, if the fracture can be treated with a short procedure or outpatient surgery, it may be covered under day care treatment.

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