What Is The Difference Between Day Care Treatment And OPD Treatment

4 min read

Though medical insurance is a must have in present circumstances, one cannot buy an insurance without considering the significant factors associated with an insurance policy. Thus, when you are planning to buy an insurance, you must read the details of the policy and take into consideration all the important factors before finally buying the plan.

Some such factors include, coverage of outpatient (OPD) treatment, coverage of day care, sum insured amount, premium levied on policy, process of claim settlement, along with inclusions and exclusions available, and so on.  Health insurance policies normally cover medical and surgical expenses caused due to ill health or injury of the insured person along with covering expenses for individual hospitalization by either paying directly to the hospital or by reimbursing the costs.

Read on to know about the differences between OPD treatment and day care treatment in health insurance.

Also Read: Can you get a Cashless Facility for Daycare Treatments? If yes, how?

What is OPD Treatment?

OPD or the outpatient department is a treatment that offers regular medical visits or checkup at a clinic. In this case, you are not required to be admitted in a hospital. Here, the doctor might offer the treatment at his own clinic or even in hospital. However, he will not admit you in the hospital, rather will have your checkup done within a few hours.

Many health insurances include OPD coverage including consultation fee, fee of pathological tests, examination etc. Some insurances also cover day-care coverage, maternity coverage, and dental treatment coverage in the policy.

Though both OPD and Day care treatment look similar, there is a difference between the two in terms of hospitalization. For OPD hospitalization is not needed to complete the check-up. But in Daycare you might be hospitalized for a short duration, which is less than 24 hours.

For instance, if you get a root canal treatment done to your tooth, you may not be hospitalized for the treatment but you can simply visit the clinic of your dentist to get the treatment.

Day-care Treatment Meaning

A medical or surgical procedure in a health treatment that requires less than 24 hours hospitalization is known as Day Care Treatment in insurance. A policy that offers cover for day care treatment is useful for the insured person. In this case, the insurance owner doesn’t need to be in the hospital for a long period. Here’s a day care treatment list or the list of treatments where daycare facility is required. However, this list is not all-encompassing as there are many other treatments where daycare facility is recommended.

  • Chemotherapy
  • Dialysis
  • Tonsillectomy
  • Cataract surgery
  • Dental surgery, etc.

Similarity in OPD Treatment and Day Care Treatment

There are some similarities between OPD and Day Care treatment:

  • Policy with OPD treatment feature allow insured person to get treatment for a short duration for their health problem without hospitalization.
  • This is same even in case of daycare treatment, where the feature allows an insured person to get treatment for a short duration for their health problem. However, it might require hospitalization for some hours.
  • Thus, both the treatments are faster.

Differences in OPD Treatment and Day Care Treatment

Here are the differences between OPD and Day Care therapy:

  • Hospitalization: In OPD, hospitalization is not necessary. But in Day Care, you might get hospitalized for few hours (less than 24 hours).
  • Scope of Coverage: A large number of health policies offer Day Care procedure depending on the policy. But in case of OPD, the cost of treatment is mostly excluded from the policies. Though some policies which offer such facility explicitly declare it in their policy document.
  • Level of Coverage – In case of daycare treatment, there is no restriction on treatment coverage as they are covered up to the sum insured. But in case of OPD treatment, it has a sub-limit and is not covered up to the sum insured.

Also Read: Does Health Insurance Cover Infertility Treatment?

Claim Process in OPD Treatment

The claim process of OPD treatment is very simple:

  • All you must do it to submit the relevant documents of the OPD.
  • And place claim for the OPD treatment.
  • However, there are sub-limits in case of OPD settlements.

Claim Process in Day Care Treatment

  • This is similar to regular hospitalization.
  • You must fill the form as in the case of regular hospitalization.
  • You must undergo treatment in the network hospital to take benefit of the cashless facility.
  • Here, you must notify the health insurance company beforehand and present the necessary papers in advance.
  • If you undergo treatment in non-network hospital, you can get the compensation by presenting the papers within 7 working days.

Conclusion

Irrespective of the treatment, a health insurance provides an insured person a reassurance securing his/her health and money. Especially when it comes to one being a sole bread winner in the family, it is very important to have an individual health insurance so that the person stays healthy, and his emergency health requirements can be met.

Similarly, family insurances allows security of the entire family in case of an emergency. Moreover, even in case of normal hospitalization of elderly or any other member of the family, floater insurances can come to your rescue if you don’t have enough savings in hand. You can also benefit from the cashless facility offered in many insurance policies along with availing benefits of OPD, Daycare and several other facilities.

However, the most important thing before considering a plan for yourself or your family is to make sure to read the documents and terms very well. This way, you will not miss out on an important point or feature that you may want to avail.

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Gayatri Prabhu, Head-Digital Business at Mahindra Insurance Brokers Limited (MIBL) is one those few digital leaders who has the width and depth that is required to execute an ROI driven holistic digital strategy. She cuts through the noise, identifies the critical levers and leads her team to successful execution of the defined strategy. Her core mantra to win new and retain existing customers is: understand the consumer behavior and craft experiences around it.

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