There are many risk-free surgeries and treatments like cataract, fistula, angiography etc., which do not require the patient to stay in hospital for more than 24 hours. The ease of these treatments has made it easy for people to go through such procedures without any health hassle. However, since these treatments do not require 24-hour hospitalization, it was difficult to get them reimbursed from the insurance company earlier.
However, IRDAI (Insurance Regulatory and Development Authority) stated that insurance companies should boost penetration of health insurance in rural areas. Thus, IRDAI sought insurers to include the Day Care Treatment feature under their health insurance policies. Let us understand day care meaning in health insurance, in this post.
The advancements in the medical industry have made it possible to get the treatment of some illnesses at a fast pace which normally doesn’t require the patient to stay in the hospital for more than 24 hours. These procedures are known as Day Care treatments or procedures. For instance, cataract surgery, nasal sinus aspiration, and so on.
Below are the points that qualifies a condition as day care treatment in health insurance
In the past, most health insurance policies covered the cost of hospitalization beyond 24 hours. Hence, day care facilities were not considered under these policies. However, with technological advancements, many health procedures can be operated and treated within a short time duration. Moreover, such patients were not required to be hospitalized for more than 24 hours in the hospital.
Looking at the scenario and the need of the moment, IRDAI has introduced the Day Care procedure under health insurance policies.
The day care treatments that are covered by health insurance policies are related to surgeries or operations which need the policyholder to stay in the hospital for less than 24 hours. For instance, eye surgery/cataract, dialysis, chemotherapy, and so on.
All the short duration medical procedures are not covered under day care procedures. There are some treatments that require OPD treatment. OPD means in the hospital Outpatient Department and the treatments that come under OPD are not considered as day care procedures.
For example, minor injuries, seasonal diseases, and health check-ups done on a regular basis and so on. These procedures do not need surgery and hence they are not covered as day care treatments.
Below are some day care procedures that are covered under Day Care treatment of health policies:
|Angiography, Chemotherapy, Radiotherapy
When it comes to day care procedures, they are not only bound by the operations and surgeries. In fact, day care treatments involve other healthcare expenses like diagnostics, medications, health check-ups, injections and so on. When you count all such these together, the total expense of a particular treatment goes much higher. In such a situation, your health insurance comes to your rescue.
Like you fill the claim form in case of in-patient treatment, the same process is followed for filing claims for day care procedures. You can either go for a cashless process of settling claims or may seek the reimbursement claim settlement method.
The full form of OPD is the Outpatient Department. Under OPD, patients visit hospitals if they suffer from any disease so that they can consult the issue with the doctor and start the treatment. Here are some key differences between OPD and Day Care Procedure:
|Day Care Treatment
|Compulsory hospitalisation of less than 24-hour
|Hospitalisation not required
|Extent of coverage
|Coverage offered to the extent of complete sum insured
|Coverage offered up to a limited sum depending on the policy
|Cataract surgery, angiography, chemotherapy, etc.
|General medical consultation, health check-ups, minor injuries etc.
Day care procedures are generally included under health insurance policies and are not required to be opted separately.
Yes, day care procedures cover all insured individuals including senior citizens.
There is a list of day care procedures covered under most health insurance policies and it depends from insurer to insurer.
Day-care treatments can usually be claimed up to the sum insured amount.
You can use google or other such search engine platforms to find a day care centre and the fee for particular procedures.
* Rs. 245/month is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*! Rs. 334/month is the starting price for a 10 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*@ Rs. 12/day is the starting price for a 5 lac family health insurance for an 25-year-old male and 22-year-old female, with no pre-existing diseases.
*# Rs. 12/day is the starting price for a 5 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*$ Rs. 600/month is the starting price for a 20 lac health insurance for an 25-year-old male, with no pre-existing diseases.
*^ Rs. 12/day is the starting price for a health insurance that covers coronavirus for an 25-year-old male, with no pre-existing diseases.