Day Care Procedure Coverage - Importance in Health Insurance

What is a Day Care Procedure?

If new to the world of health insurance, you must have come across multiple terms such as inpatient treatment, pre-hospitalisation, post-hospitalisation, co-payment, and others. Also present, in the list, is the term ‘Day Care Procedure’. 

Day Care Procedure is a surgery or a medical procedure that formerly demanded a prolonged or at least one day of stay in the hospital, but can now be completed in a period of less than 24 hours, owing to technological advancements. Also known as ‘Short-term hospitalisation’, day care procedures are undertaken in not less than 2 hours and not more than 24 hours.

What All is Included?

While many health insurers cover only specific day care procedures under their health insurance plans, there are also insurers that cover almost all day care procedures. 

The list of day care procedures includes Appendectomy, Cataract, Dialysis, Angiography, Radiotherapy, Tonsillectomy, Chemotherapy, Septoplasty, Procedure for Sinusitis, Piles/Fistula Treatment, Colonoscopy, and others. 

Why Health Insurance Day Care Procedure Coverage is Beneficial for you?

A health insurance plan that includes coverage for day care procedures is of massive advantage.

One of the biggest reasons that people choose health insurance with day care procedures is because it helps them ‘Prevent Financial Instability’ due to heavy hospitalisation bills. Irrespective of the fact that most day care procedures don’t require extended hospitalisation, they come across as expensive. In fact, even diagnostic tests (not requiring hospitalisation or treatment) can burn a hole in one’s pocket. This is where day care procedure coverage comes to rescue. 

Other key causes include - 

• Peace of Mind: When you have day care procedure coverage in your health insurance plan, it becomes easy for you to concentrate on the treatment/procedure rather than expenses. You stay away from stress of any kind. 
   
• Cashless Service: You can opt for cashless health insurance claim settlement (if provided by insurance company) for a day care procedure, which you know in advance that you or any of your family members will be undergoing. 
   
• Superior Medical Care: When availing treatment for day care procedures in a network hospital of your health insurer, you not only can expect cashless service, but also the best possible medical care. High quality treatment, even for a short-term hospitalisation is possible.
   
• Tax Benefits: When you choose a health insurance plan with day care procedure coverage, it gives you an added tax saving benefit. 

How to Choose Health Insurance Plan Covering Day Care Procedures?

When looking for a health insurance plan that covers day care procedures, remember to differentiate between quantity and quality. 

Many health insurance companies, while selling their health insurance plans, shed light on the ‘number of day care procedures covered’, so that the customers get attracted and opt the plan straightaway.

While many people commit this mistake, it is advisable to look for day care procedure coverage in a broader sense. Choose health insurance plans with broader categorisation such as Oncology, Angiography, and others instead of ones that list specific procedures. The broader the category, the more surgeries and procedures it will cover.

Also remember that making the right decision will demand focus on age limit, co-payment, sub-limit, availability of cashless facility, and other factors along with the number of day care procedures. 

Selecting health insurance plan based on the number of day care procedures covered alone will do no good to you. 

Nonetheless, thinking in terms of broad categorisation and considering a few key aspects will help you make a worthy investment. 

Difference Between OPD Treatment and Day Care Procedures?

The coverage of OPD treatment in health insurance plans that feature day care procedure coverage also creates confusion for a lot of policyholders. Health insurance plans like such, cover treatment that neither require 24-hour hospitalisation nor they come under the category of day care procedures, thereby leaving the policyholder with a dual mind. It is important to end any kind of confusion between OPD cover and day care procedure cover. 

The basic difference lies in the nature of procedures covered and the level of hospitalisation. 

Firstly, note that while OPD includes procedures with minor medical expense, day care procedures is associated with expensive procedures that otherwise would have demanded 24 or more hours of hospitalisation had technological advancements in the medical field not been there. 

Secondly, it is important to understand that while OPD treatment are performed without the need for hospitalisation, day care procedure require one to be hospitalised for treatment, even if it is for a short time period. 

P.S. In the case of day care procedures, you will find it clearly mentioned that if a treatment is done on an outpatient basis, i.e. without being hospitalised, the claim will not be considered under the category of day care procedure.

Procedure for Filing Day Care Procedure Claim?

The procedure for filing day care procedure claims is quite similar to that of a regular health insurance policy. If it is a planned day care procedure treatment, you can go for the cashless treatment mode by informing your health insurer in advance (some insurers require it).

If treatment is on reimbursement basis, rest assured your health insurer will reimburse the amount after you submit the required documents. 

Also Read

Claims Ratio in Health Insurance - Importance

Covering OPD Cover in Health Insurance

Conclusion

Day care procedure coverage is a beneficial in-built feature of most health insurance policies. 

To make the most of this superior feature, choose a health insurance plan only after reading all the policy related documents carefully.