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- What do Daycare procedures include?
- Choose the right Health Insurance plan for Daycare procedures
- Expenses covered in Daycare procedures under Health Insurance
- Difference between a Daycare treatment and an OPD treatment cover
- Understanding Daycare Health Insurance plans
- Benefits of a Daycare Health Insurance plan
- List of daycare treatments covered under the Health Insurance Plan
- Things to consider when choosing a Daycare treatment coverage
- Process of filing Daycare procedure claims under Health Insurance
- Know why dental treatments are not covered under Daycare Health Insurance
- FAQS - FREQUENTLY ASKED QUESTIONS
Many consumers believe Health Insurance coverage does not cover small expenses and over-the-counter costs. It is a misconception that Health Insurance does not cover Daycare treatments. Daycare procedures are treatments that do not require 24 hours of hospitalisation.Many Health Insurance providers include Daycare Insurance in their coverage. You must thoroughly review the terms and conditions, coverage, and claims to choose the right plan. The Insurance Regulatory and Development Authority (IRDAI) has asked insurance companies to include more daycare products in their coverage.Also read: What Is Health Insurance – Types, Features & Benefits
What do Daycare procedures include?
Daycare procedures include medical operations and treatments that require less than 24 hours of hospitalisation. Cancer chemotherapy, radiotherapy, appendectomy, eye surgery, piles/fistula, sinusitis, dialysis, angiography, etc., are some types of treatments. At the same time, OPD consultations are related to fractures, sprains, and other less complex procedures.People tend to purchase separate Health Insurance for OPD coverage, unaware that their existing Daycare Insurance plan may also have coverage for OPD expenses. Many Health Insurance plans cover Daycare treatments and OPD expenses with broader coverage.Also read: Complete Your Health Insurance Plan With an OPD Cover
Choose the right Health Insurance plan for Daycare procedures
Choosing better coverage for your Daycare Health Insurance is necessary. Many insurance companies offer broader coverage policies for illnesses and diseases. Some other plans offer coverage for a specific category of disorders. It is good to opt for the broader category plans rather than specific ones, as it involves all the illnesses, including minor and major treatments.For example, opt for the broader category plan, like oncology, instead of a policy that covers a list of specific treatments like radiotherapy, chemotherapy, etc. Plans with broader categorisation will cover all the new treatments in the future, which may not be covered in any specified insurance coverage.
Expenses covered in Daycare procedures under Health Insurance
Daycare procedures under Health Insurance go beyond operations and surgeries. It involves many costs, like diagnostics, hospital admissions, vitals, injections, etc. Health Insurance plans also cover many post-hospitalisation expenses, like consultation fees, medication costs, follow-ups, test charges, etc. And if your insurance policy includes nursing costs at the post-hospitalisation expense, you can claim those, too.Usually, Health Insurance plans also give maternity and dental coverage, ultimately covering your additional expenses. Daycare Insurance and OPD coverage pay off your diagnostic tests, pharmacy bills, and consultation charges.It is essential to read the policy document thoroughly so you understand the terms and conditions of the insurance plan before you buy it. Ignorance in this respect will cause you to incur unnecessary expenses in the future.Also read: Pre-Hospitalisation and Post-Hospitalisation Expenses in Health Insurance
Difference between a Daycare treatment and an OPD treatment cover
Some Health Insurance companies provide OPD expense coverage, including dental and maternity expenses. This is not the case with Daycare Insurance. The Daycare procedures under Health Insurance coverage are expensive compared to OPD expenses.
Key Differences between daycare procedures and OPD treatment coverage are:
| Factors | Day care treatment | OPD treatment |
| Hospitalisation | Less than 24 hours of hospitalisation is required. | Hospitalisation is optional. |
| Examples | Cataract operation, corneal incision, radiotherapy, chemotherapy, skin transplantation, ligament tear, etc. | Regular consultations for illness or seasonal flu, minor dressing, burn injuries, health checkups, fractures, etc. |
| Coverage | Covered up to the total sum insured. Claims include pre and post-hospitalisation expenses. | Limited up to a specific amount. Varies, according to the insurer, some offer ₹ 5,000 per year, while some offer ₹ 8,000 per year. |
Understanding Daycare Health Insurance plans
Any medical procedure, such as surgery or other operations that do not necessitate a 24-hour hospital stay is commonly called a Daycare procedure. Many Health Insurance companies provide medical benefits to cover the expenses of these treatments. It covers an agreed portion of the expense, while some pay for the entire treatment. The terms and conditions related to coverage vary according to the company and situation.
Benefits of a Daycare Health Insurance plan
- A Health Insurance plan for your Daycare treatment can reduce stress. You won’t have any tension paying for the treatment out of pocket. Insurance coverage will cover all your Daycare treatment costs.
- In case of any planned Daycare treatment, you can inform third-party administration (TPA) about the treatment and its nature beforehand. It will provide you with the benefit of cashless treatment.
- You can enjoy tax benefits against your Daycare procedures. Once you pay the premium for Health Insurance plans, you can enjoy benefits under section 80D of the Income Tax Act.
- Daycare Insurance plans allow you to get treatment from any network hospital that gives high-quality care and a better patient environment.
List of daycare treatments covered under the Health Insurance Plan
Following are the daycare treatments that are covered under the Health Insurance plan:
| Type of treatment | Details |
| Ear operations | Auditory ossicle and middle ear reconstruction, inner ear fenestration, tympanoplasty, and tympanic drain removal. |
| Nose, nasal sinuses | Turbinates surgery, reducing and destroying the tissue of the infected nasal and aspirating the nasal sinuses. |
| Ophthalmology | Cataract surgery, removal of tear glands and foreign objects from the cornea, eye lens, conjunctiva, canthus and epicanthus procedures and removing diseased eyelid tissue. |
| Orthopaedics | Treatments include sutures on tendons and tendon sheaths, aseptic and septic bone incisions, arthroscopic knee aspiration, and osteosynthesis. |
| Subcutaneous tissues and skin treatment | Skin cancer treatment, skin transplantation, local excision, skin plasty revision, and skin cancerous tissue removal. |
| Some other treatments like cancer, heart disease, and complications in urinary and sexual organs are also included in daycare insurance. | |
Things to consider when choosing a Daycare treatment coverage
Daycare treatment under a Health Insurance plan protects individuals against financial loss because of expensive medical treatments. Most Health Insurance companies showcase the maximum number of Daycare procedures they offer under their policy to attract customers. Due to this, customers with less information buy their plan and usually opt for the wrong health policies. Choosing a plan based on the maximum number of daycare procedures offered listed in the medical plan is insufficient. To choose the right treatment coverage, you must check other features like cashless facilities, sub-limit , age limit, amount insured, etc..The following are the things that one should keep in mind before investing in Daycare Insurance.
- Type of policy Know your requirements, whether you need an individual policy or a family floater option. Check if your requirements align with the policy coverage or not.
- Amount insured Medical inflation is the key factor to consider when choosing a policy. This factor has made Daycare treatments more expensive; thus, the sum insured must meet the expenses of healthcare needs.
- Exclusions Before finalising any policy, check all its exclusions. Read the policy carefully and understand the cases where you will not be eligible to claim insurance.
- Network hospitals To get high-quality or cashless facilities during treatment, review the network hospital lists under the Health Insurance policy. Moreover, check if the network hospitals are near you for immediate access to medical care.
- Co-payment Check for the co-payment clause so that you are prepared to bear certain expenses incurred during the treatment.
Also read: Focus on These 5 Factors to Buy the Best Cashless Health Insurance Policy
Process of filing Daycare procedure claims under Health Insurance
Filing a claim for Daycare treatment is the same as a regular Health Insurance policy. You must inform the insurer of the hospitalisation and the expenses incurred within the stipulated time. These steps will avoid all the last-minute hassles. If you are get treatment from a network hospital, you can choose the cashless facility, where you do not need to make any upfront payments. You only need to contact the insurance desk, submit a pre-authorised form, and show your health card and valid ID proof to get the benefit of Daycare Insurance.If you get treated in a non-network hospital, you may have to apply for a reimbursement claim by submitting the required documents like medical bills and a medical practitioner’s referral letter for hospitalisation.Also read: What Are Network And Non-Network Hospitals? How Does It Affect Your Health Claim?
Know why dental treatments are not covered under Daycare Health Insurance
Health Insurance policies usually do not cover dental procedures like screening, crowning, fillings, or extractions. So, when you get Health Insurance, ask the policy agent if the dental treatment gets covered under the Mediclaim policy. Some Daycare Insurance plans offer dental and even maternity coverage only if you opt for OPD (Outpatient Department) benefits.Usually, Daycare Insurance companies do not cover dental braces for adults over 18. Therefore, reviewing the policies and claims before you purchase a plan is essential. If you are seeking dental insurance coverage, you have the option to select from various plans, including a Dental Preferred Provider Organisation (PPO), a Dental Indemnity Plan, or a Dental Health Maintenance Organisation (HMO)
FAQS - FREQUENTLY ASKED QUESTIONS
What are the examples of pre and post-hospitalisation expenses ?
Post-hospitalisation expenses are charges incurred after the patient’s discharge from the hospital. The post-discharge expenses include consultation fees, medication costs, follow-up treatments, test charges, etc. Pre-hospitalisation expenses are medical costs incurred before getting admitted to the hospital. They include costs like diagnostics, hospital admissions, vitals, injections, etc. Health insurers cover the pre and post-hospitalisation expenses.
What does Daycare Insurance mean in Health Insurance ?
Daycare Insurance is a part of some Health Insurance policies offered by companies to cover all the Daycare treatment expenses of the consumer. Daycare treatment is a surgical or medical procedure carried out under local anaesthesia and requires less than 24 hours of hospitalisation. Many healthcare plans include these treatment expenses in their coverage to benefit consumers by reducing medication costs.
Does Daycare Health Insurance cover dental treatment ?
Daycare Health Insurance companies do not cover treatments that are pre-planned or cosmetic. Most Health Insurance plans exclude elective procedures done for aesthetic purposes. But insurers cover such expenses if any dental complication arises due to accidental injury or illness. Insurance plans do not exclude all dental costs. Before you buy a plan, be aware of the claims, limitations, and terms and conditions of all those Daycare Health Insurance policies.
How do you file a claim for Daycare Health Insurance ?
You can file a claim for Daycare Insurance like any other Health Insurance policy, as this insurance has a built-in policy coverage feature. You can use the cashless claim route if you follow a planned procedure. However, you need to inform the insurance company of the claim process.
The insurance company will reimburse your claim amount after you submit all the required documents. The procedure for claiming the pre- and post-hospitalisation benefits covered under the policy is the same, and the insurance company reimburses all the expenses incurred.
Why are Daycare Health Insurance plans beneficial ?
Daycare Insurance plans offer many benefits to individuals and their families.
Some of the significant benefits of Daycare Health Insurance plans are as follows:
It covers all the heavy expenses of critical medical Daycare treatments and significantly reduces stress.
At times of planned treatments, the insurance provider will help you get an option of a cashless claim when informed beforehand.
You can enjoy the tax benefit under section 80D after paying the premium for your insurance.
It will allow you to get treatment from the best and most high-quality doctors and hospitals in a better environment.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
