What Is The Difference between OPD and Daycare Treatment?

When it comes to buying a health insurance policy , many people tend to take a hasty decision. As a result, they ignore the important features of the policy. While buying a health cover, you must consider several factors, including the claim amount, the claim settlement process, policy inclusions and exclusions, coverage for daycare and OPD treatment, etc.If you are not aware of the difference between daycare treatment and OPD coverage, we list down the differences and the claim procedure.

OPD is an acronym for the Outpatient Department. In OPD treatment, the patient does get hospitalised. Generally, the patients who visit the OPD to seek consultation from the doctor and avail treatment for a specific disease/illness.If your health insurance policy includes OPD coverage, it pays for doctor’s consultation fees, pathological tests (if prescribed by the doctor for detailed assessment for the condition), and medicines. Depending on the type of health care plan you hold, it may also include maternity treatment coverage.

As the name suggests, the daycare treatment is completed within a few hours on the same day as the patent’s visit to the hospital/clinic. Like the OPD treatment, the patients visit the doctor’s office for a consultation and do not require hospitalisation.An example of daycare treatments includes cataract surgery, dental procedures, chemotherapy, and many others.

While at the outset, both daycare treatment and OPD treatment may look the same, there are many differences, and knowing the fine line would help get the most of your health insurance policy.

Hospitalisation

In the case of daycare treatment, depending on your health condition, the doctor may advise you to get admitted to the hospital (usually for a few hours) for treatment. But, in OPD treatment, hospitalisation is not required; the doctors only provide consultation.

Scope of coverage

One of the significant differences between daycare treatment and OPD treatment is that most insurance companies provide coverage for daycare procedures. Whereas the latter is generally excluded unless it is specifically mentioned in the policy documents. The coverage for daycare treatment may vary from policy to policy.

Coverage amount

Generally, for daycare procedures, you are entitled to get compensation to the limit of the plan’s sum assured. Whereas, for OPD treatment, the insurers may include a sub-limit clause, which means you will get coverage only to a certain limit, beyond which you must pay from your pocket.Now that you know the difference between daycare treatment and OPD treatment, it would help to understand the claim filing process for the two.For daycare procedures, the claim process is similar to regular hospitalisation. You can avail cashless claim facility by undergoing the treatment at any of the network hospitals of your choice. But, before you file the claim, you must inform the insurance company about the treatment availed and submit the relevant documents. If you seek treatment at a non-network hospital, you can claim reimbursement by submitting the necessary bills and other documents required by the insurer.For OPD treatment, you can claim the expenses incurred by submitting the necessary documents. Remember, not all plans cover OPD treatment, and it may be subject to sub-limit. So, be aware of the policy’s terms and conditions while filing the claim. Final Word Often, the health insurance policyholders find the policy wordings confusing. But you must understand the underlying differences to make a valid claim. It is like taking a bitter-tasting medicine, you may not like the taste, but you take it anyway for better health. So, what is the harm in understanding a few technical terms to get your claim settled?

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.