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Day Care Treatment and Procedures Covered Under Health Insurance

Who loves to stay in the hospital when you can get discharged in just 24 hours with the help of highly advanced treatments? Day care procedures make it possible!

From minor surgeries to chemotherapy and even eye surgeries, these treatments ensure that you receive top-notch medical care without the hassle of a long hospital stay.

With health insurance plans now covering a wide range of daycare treatments, you can focus on a speedy recovery without worrying about the costs. Read this article to know what day care treatments are covered by health insurance.

Team Digit

What is Day Care Treatment?
What Qualifies Day Care Treatment?
Are Day Care Procedures Covered in Health Insurance?
List of Day Care Treatments
What is Covered and Not Covered?
Benefits of Day Care Treatment
Day Care Procedure Vs OPD
How to Claim Day Care Expenses
Frequently Asked Questions

What is Day Care Treatment in Health Insurance?

Daycare treatments in health insurance refer to medical treatments and procedures that require hospitalization, but not for more than 24 hours. These treatments are possible only because of medical advancements and technology which makes the treatment processes are now much shorter!

Popular examples of daycare treatments include cataract surgeries, nasal sinus aspiration, cancer chemotherapy, cancer radiotherapy, etc.

Digit Simplification: Why stay in a hospital unnecessarily when the required procedure takes just a day?

What qualifies as a Day Care Procedure/Treatment?

Note: The important thing to keep in mind about daycare procedures is that, not all short-term treatments are considered as daycare procedures. Hence, the same shouldn’t be confused with OPD consultations.

Daycare treatment strictly refer to treatments, surgeries and operations, that require hospitalization for less than 24 hours due to advancement in medical technologies and procedures.

Whereas hospitalizations of over 24-hours are covered under “hospitalization expenses” in your health insurance, and OPD consultations required for smaller medical concerns like fractures, sprains and other doctor consultations are covered under OPD benefit or OPD cover, as specified by your health insurance policy.

Importance of Having Daycare Treatment Cover Under Health Insurance

Are Day Care Procedures Covered in Health Insurance?

Yes, day care procedures are often covered under health insurance as they provide financial relief in case of emergency.

These include treatments like cataract surgeries, chemotherapy, radiation therapy, dialysis, hymenectomy, and arthroscopic knee aspirations among many other procedures.

Given the fact that many such treatments can be done under 24-hours and are not only needed by many patients but also include high healthcare expenditure, the IRDAI (Insurance Regulatory & Development Authority of India) introduced the same in health insurance policies.

Thank God for that! Thereby, daycare procedures refer to such treatments that require hospitalization of less than 24-hours due to medical advancements.

A good example of the same would be, when someone has to be admitted into the hospital for a cataract surgery, post which he/she will also receive care at the hospital and then be discharged within the same day itself.

List of Day Care Treatments Covered Under Health Insurance

From eye surgeries to chemotherapy, the day care treatment list never ends. Here is a precise list of diseases that are treated in a day and covered under a daycare treatment in a health insurance policy.

Root canal surgery	Cataract surgery
Kidney dialysis	Tonsillectomy
Angiography	Radiotherapy
Adenoidectomy	Septoplasty
Chemotherapy	Arthroscopy for joints
Minor skin surgeries	Piles surgery
Immunotherapy	Oral chemotherapy
Stem cell therapy	Bronchial Thermoplasty

Disclaimer: The above list of daycare treatments is for representation purposes only. Please refer to your specific policy document to understand the treatments covered by your insurer, as the list may vary based on your health insurance plan.

What is Covered and Not Covered in Day Care Treatment Under Health Insurance?

So far, we know that Day care treatment only includes the treatment that are done within 24 hours. However, not all treatment are included. It is essential to review your policy for a complete understanding of what is covered and excluded under the day care procedure in your health insurance.

What is Covered in Day Care Treatment?	What is Not Covered in Day Care Treatment?
Medical costs related to any surgery, treatment, or operation that requires the policyholder to spend fewer than 24 hours in a hospital are covered by day care coverage in health insurance.	Not all short-term medical procedures are covered by health insurance for day care services. Procedures overseen by the Outpatient Department (OPD) do not qualify as day care services.
Dialysis, chemotherapy, eye surgery, and any other illness or injury that requires only a few hours of hospitalization are excellent examples of day care treatments.	For instance, OPD takes into account routine visits, seasonal illnesses, minor injuries and medical consultations. Since these operations don't involve significant surgery, they aren't considered day care services.

Things to Know About Day Care Treatment Coverage in Health Insurance

If you have a health insurance plan, you can rest assured that your insurer will cover your day care procedures. However, there are some important things you must know about day care procedure in health insurance:

Sum Insured: Ensure that the sum insured in health insurance is sufficient to cover the costs of your daycare treatments, ensuring adequate financial protection.
Inclusions and Exclusions: It is crucial to thoroughly review the policy document to understand which treatments are covered and which are excluded from the day care procedures under your insurance plan.
Co-payment: Be aware of any co-payment clauses in your policy, as these may require you to pay a portion of the treatment costs out of pocket.
Waiting Period: This refers to the time frame you must wait before you can claim for a specific condition. It’s important to check the waiting period in health insurnace for the particular treatment you need.

List of Network Hospitals: Review the list of network hospitals your insurer provides. Shortlist the nearby hospitals, making it easier to access cashless claim facilities when needed.

Benefits of Day Care Procedure Coverage in a Health Insurance

Daycare procedures go beyond just the operation or surgery. Daycare treatments usually involve many expenses, such as diagnostics, medications, hospital admission, vitals, injections, and post-hospitalization expenses. Here are some benefits of daycare hospitalisation procedures in health insurance:

Financial Protection: Even with their reduced duration, daycare procedures can still be costly. Insurance coverage helps with cost management and protects you in an emergency.
Broad Coverage: Both major and minor procedures are covered by medical needs. With day care coverage, you're covered for various health situations.
Convenience: You don't need to stay in the hospital for long to receive the necessary treatments. You will be treated and recover faster.
Comfort: Knowing you are insured for these day care treatments helps ease your anxiety about any medical problems.
Faster Access to Treatment: You might receive the care you require more quickly because day care procedures sometimes have shorter waiting times than inpatient procedures.

What is the Difference Between a Day Care Treatment and OPD Treatment Cover?

Many of you might get confused between a daycare procedure and outpatient department treatment, but they are a Day Care treatment is widely different from a day:

Factors	Daycare Treatment	OPD Treatment
Meaning	Day care procedures refer to treatments requiring hospitalization, but only below 24-hours due to medical advancements.	OPD translates to Out Patient Department and refers to daily doctor consultations or smaller treatments like minor stitches and fractures.
Hospitalization	Hospitalization required < 24 hours	No hospitalization required
Examples	Examples of daycare procedures include cataract surgery, chemotherapy, ligament tear, kidney dialysis, corneal incision and radiotherapy, among many others.	Examples of OPD include regular doctor consultations for any illness or disease, such as for a seasonal flu, minor dressing due to an injury, regular health checkups and consultations among others.
Coverage	Health insurance usually covers daycare procedures up to the total Sum Insured. This includes all pre and post-hospitalization expenses related to the daycare treatment being claimed for.	OPD benefits or OPD covers in health insurance are usually limited up to a specific amount and differs from insurer to insurer. For example, many health insurers offer OPD, up to Rs 5,000 per year.

How to File a Claim for Day Care Treatments?

Claiming a daycare procedure is almost similar to making a claim for an inpatient treatment. The claim process depends on the hospital you choose. If you have opted for a network hospital, you can go for a cashless claim and if you have selected a non-network hospital, you can make a claim through a reimbursement claim process.

Cashless Claim

Step 1: Notify your insurer and select a network hospital for your day care surgery before your hospitalization.

Step 2: Show your e-health card at the network hospital helpdesk and ask for the pre-approval.

Step 3: Fill out and sign the form and submit it to the helpdesk.

Step 4: After verification, the insurance company will take care of your day care treatment.

Reimbursement Claim

Step 1: If you select a non-network hospital and undergo a daycare procedure, keep all the medical bills, reports, and other essential expense documents with you.

Step 2: After treatment, contact your insurer and provide them with all the soft copies of the documents and bank account details for reimbursement of expenses.

Step 3: The insurer will verify the documents, and you will receive a reimbursement for the daycare procedure expenses.

FAQs about Day Care Treatment in Health Insurance

All

Do I need to opt for daycare treatments or is it already included in my health insurance?

Fortunately, no! Daycare procedures are already included in your health insurance. You need not buy a separate add-on for the same.

Are there any daycare procedures for the COVID-19?

No, there are no specific daycare treatments prescribed for the COVID-19.

How many daycare procedures are covered in a health insurance?

The list of daycare procedures covered in a health insurance varies from insurer to insurer. However, most health insurers cover up to 100 different daycare treatments!

Is there a specific amount up to which I can claim for a daycare treatment?

With Digit’s health insurance covering daycare treatments, daycare treatments will be covered up to your total sum insured.

Are daycare procedures covered for seniors?

Yes, daycare procedures are covered for seniors as well.

What are the daycare treatments in health insurance?

In simple words, medical operations that don't need an overnight hospital stay are referred to as daycare treatments. The average stay for these treatments is less than 24 hours from admission to release.

Many illnesses can now be treated this way because of advancements in medical technology, which makes healthcare more accessible.

What is the day care coverage meaning?

Medical costs related to any surgery, treatment, or operation that requires the policyholder to spend fewer than 24 hours in a hospital are covered by daycare coverage in health insurance. Some examples include dialysis, chemotherapy, eye surgery, etc.

What are the benefits of daycare?

Daycare treatment has various benefits, such as:

Provides wider coverage by covering one day of hospitalization.
Easily convenient as it doesn't require long hospital stays.
Provides you peace of mind by covering you thoroughly.

What is daycare reimbursement?

Daycare treatment reimbursement is the amount you can claim after undergoing any treatment in less than 24 hours. You can submit your treatment bills to your insurer to claim the money back that was spent in your treatment procedure.

How is daycare treatment different from regular hospitalization?

Regular hospitalization requires an overnight stay, while daycare treatment is a medical procedure that necessitates hospitalization but is finished within 24 hours. Patients receiving daycare treatments are admitted in the morning and released from a hospital or other medical facility the same day.

Which medical procedures are considered daycare treatments?

Medical procedures that are considered daycare treatments include cataracts, chemotherapy, radiotherapy, lesion removal, piles, incisions, foreign body removal, etc.

Do daycare procedures require pre-authorization from the insurance company?

Yes, the daycare procedure requires insurance companies to pre-authorize it. Usually, this entails filling out a form with information about the treatment you are undergoing. You can also get assistance with this process from your insurance company.

Are there any specific exclusions for daycare treatments in health insurance?

Yes, there are certain exclusions that are not included in daycare treatments covered by health insurance. These include certain surgeries such as cosmetic surgery and OPD charges. Always check with your insurance provider before buying health insurance with treatment coverage.

How many hours of hospitalization are needed for daycare treatment to be covered?

Any treatment done within 24 hours of hospitalization is considered a daycare treatment.

Does the waiting period apply to daycare procedures?

Yes, the waiting period applies to a health insurance policy that covers daycare procedures. The initial waiting period is 30 days and the specific illness waiting period is 2 years. Always check with your insurance provider for the waiting period.

Can daycare treatments be availed at any hospital, or are there specific network hospitals?

The daycare treatments can be availed at any hospital, whether at an insurance company network hospital or a non-network hospital. After the treatment, you can apply for a cashless claim in a network hospital or ask for reimbursement if your daycare treatment undergoes in a non-network hospital.

Are daycare treatments covered under cashless insurance?

Yes, daycare treatments are covered under cashless insurance. Although, it can also be covered with reimbursement in non-network hospitals.

What documents are required to file a claim for day care procedures?

To file a claim for a daycare procedure, you must have the following documents: medical bills, diagnostic reports, prescriptions, claim form and your health insurance card. The claim process for daycare treatment is similar to that of an inpatient hospitalization.

Are post-hospitalization expenses covered for daycare treatments?

Yes, post-hospitalization expenses are covered for daycare treatments. However, it will depend from policy to policy. Read your policy document thoroughly.

Does health insurance cover daycare procedures related to cosmetic treatments?

No, not all health insurance policies cover day care procedures related to cosmetic treatments. However, it can be covered on the mutual agreement of policy holder and policy provider before purchasing the policy.

Can daycare treatments be done under planned surgeries, or are they only for emergencies?

Daycare treatments are provided during both, planned surgeries and in case of emergencies. If you suffer from a specific disease, daycare treatments are provided within 24 hours of hospitalization.

Are daycare treatments covered under family floater health insurance policies?

Yes, daycare treatments are covered under the family floater health insurance policy. All the family members included in the policy can be covered, but the highest coverage is offered up to the sum insured.

How do I determine if a specific procedure qualifies as a daycare treatment under my policy?

To know if a specific procedure qualifies as a daycare treatment under your policy, you must read the complete policy wording or ask your insurance provider about the coverage on the policy.

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Day Care Treatment and Procedures Covered Under Health Insurance

Table of Contents

What is Day Care Treatment in Health Insurance?

What qualifies as a Day Care Procedure/Treatment?

Importance of Having Daycare Treatment Cover Under Health Insurance

Are Day Care Procedures Covered in Health Insurance?

List of Day Care Treatments Covered Under Health Insurance

What is Covered and Not Covered in Day Care Treatment Under Health Insurance?

Things to Know About Day Care Treatment Coverage in Health Insurance

Benefits of Day Care Procedure Coverage in a Health Insurance

What is the Difference Between a Day Care Treatment and OPD Treatment Cover?

How to File a Claim for Day Care Treatments?

Cashless Claim

Reimbursement Claim

FAQs about Day Care Treatment in Health Insurance

Do I need to opt for daycare treatments or is it already included in my health insurance?

Are there any daycare procedures for the COVID-19?

How many daycare procedures are covered in a health insurance?

Is there a specific amount up to which I can claim for a daycare treatment?

Are daycare procedures covered for seniors?

What are the daycare treatments in health insurance?

What is the day care coverage meaning?

What are the benefits of daycare?

What is daycare reimbursement?

How is daycare treatment different from regular hospitalization?

Which medical procedures are considered daycare treatments?

Do daycare procedures require pre-authorization from the insurance company?

Are there any specific exclusions for daycare treatments in health insurance?

How many hours of hospitalization are needed for daycare treatment to be covered?

Does the waiting period apply to daycare procedures?

Can daycare treatments be availed at any hospital, or are there specific network hospitals?

Are daycare treatments covered under cashless insurance?

What documents are required to file a claim for day care procedures?

Are post-hospitalization expenses covered for daycare treatments?

Does health insurance cover daycare procedures related to cosmetic treatments?

Can daycare treatments be done under planned surgeries, or are they only for emergencies?

Are daycare treatments covered under family floater health insurance policies?

How do I determine if a specific procedure qualifies as a daycare treatment under my policy?

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