What is Daycare Treatment in Health Insurance?
Daycare treatment in health insurance is a medical marvel in today’s day and age. Gone are the days when you would have to get hospitalized for even minor surgeries. Due to advancements in medical treatment, and good quality access to hospitals, specific surgical processes can be conducted by doctors within a period of 24 hours (at times, even within a few hours). Such kinds of medical procedures that take less than 24 hours to be conducted are known as daycare treatments.
It is essential to avail of daycare treatments because it is less expensive than getting admitted to a hospital for 2-3 days. As an added benefit, the IRDAI (Insurance Regulatory and Development Authority of India) has directed health insurance companies to include a certain list of daycare treatments under their respective healthcare schemes. Therefore, you need not shell out money even for any of the mentioned daycare procedures ?.
Here is an example of the daycare process.
Mr. Good has kidney problems and has been told by the doctor to undergo dialysis every week. This is usually a 3 to 4-hour process, provided the patient does not have any complications.
Therefore, Mr. Good will go ahead with dialysis and, post that, will be required to stay in the hospital for observation. The entire process of dialysis plus observation time spent in the hospital comes to 10 hours. In fact, Mr. Good was discharged the same evening.
This is a daycare procedure not lasting more than 24 hours. The best part, dialysis was covered under Mr. Goods' medical coverage policy ?.
5 Benefits of Day Care Treatment in Health Insurance
Now that you know about daycare procedures let us check the advantages of having them covered under your mediclaim plan.
TypeFeatureSave moneyYes, as mentioned above, you save a lot of money since the cost of treatment is covered under your healthcare policy. Due to the recent pandemic, even minor surgeries are expensive nowadays!Good coverDaycare treatment is generally compensated up to the sum assured of your health plan.Tax benefitYou can claim income tax deductions under your health plan (Section 80D of the Income Tax Act, 1961)Cashless facilityYou can go for a cashless claims process for daycare treatment. A reimbursement option is also available.Additional benefitIn addition to the treatment, many health plans provide coverage for expenses related to daycare surgery or procedures such as medication, pos-hospitalizations, diagnostics, and much more.
What is Covered in Daycare Treatment in Health Insurance?
Every health insurance company and insurance group has a comprehensive list of daycare treatments mentioned in their respective policy document. Mentioned below is a general list.
FeatureDaycare Treatment TypeENT - Ears, nose, and
throat-relatedOperations in the middle/inner ear
Myringotomy
Septoplasty
Grommet insertion
Foreign body removal
Nasal sinus aspiration
Tympanoplasty
TonsillectomyTongue relatedReconstruction
Glossectomy
Incision and excisionEye relatedCorrective surgeries
Cataract surgery
Removal of foreign body
Tear duct operationsCancer treatmentRadiotherapy
ChemotherapyOther surgeriesDialysis
Dental related injury via accident
Skin surgery
Colonoscopy
Removal of lesion
Piles
Appendix removal
Lithotripsy
Thoracoscopy
Difference Between OPD and Day Care Treatment
Although outpatient department treatment sounds similar to the daycare process, it is entirely different and may/may not be part of your mediclaim plan. Here is a comparison table that will help you differentiate between the two types of care and cover.
TypeDaycare TreatmentOutpatient Department TreatmentDefinitionAs we learned from above, daycare procedures require in-patient hospitalization assistance for less than 24 hours.Outpatient department treatment includes your regular go-to-doctor consultation for common fever, follow-ups, medical advice, and more.Scope of CoverHospitalization may/may not be needed post the procedure. If you require hospitalization, it must be less than 24 hours.This is general doctor consultation. No hospitalization/hospital stay is needed.What is included?Daycare procedures are covered under your health insurance plan. It includes additional post-hospitalization expenses as well.OPD expenses are usually not covered. You will have to purchase it as an add-on to your base plan. Also, the cover amount is limited to Rs. 5,000 to Rs. 10,000 per year.
As a safety tip, go for a health plan that comes with a complete list of daycare treatments. In addition, do not forget to read the policy document (terms and conditions) before deciding to go ahead with medical cover. Check out more info on healthcare, daycare procedures, and wellbeing for your employees at Plum.
FAQ
Q. How does the claim process for daycare treatments differ from that of longer hospital stays?
A. For daycare treatments, the claim process is usually simpler. Policyholders must submit a claim form, discharge summary, and bills. Unlike longer stays, fewer documents are needed. Therefore, the process is faster, ensuring quicker reimbursements.
Q. Are there any specific criteria or conditions that a procedure must meet to be considered a daycare treatment under health insurance policies?
A. Yes, to qualify as daycare treatment, the procedure must not require a hospital stay exceeding 24 hours. It should be medically necessary and listed in the policy document. Therefore, checking your policy's list of covered daycare treatments is crucial.
Q. Can policyholders upgrade their existing health insurance plans to include daycare treatments if they are not already covered, and how?
A. Policyholders can often upgrade their plans to include daycare treatments by paying an additional premium. This requires contacting the insurer and requesting the addition. Therefore, it's possible to enhance coverage to meet evolving healthcare needs.
