Health Insurance

15 Day Care Procedures That Are Commonly Covered Under Health Insurance Policies

By Vikas Chandra Das
17 November 2022, 12:32 PM

A day care procedure requires less than 24-hour hospitalisation that involves medical operations, treatments and surgeries and are done under the influence of local anaesthesia in a hospital or in a daycare centre. Some examples include chemotherapy, dialysis, cataract, colonoscopy, and others. Not every short-term procedure or treatment qualifies as a day care procedure hence OPD consultations and hospitalisation that covers treatments and require more than 24 hours are suggested depending upon your health insurance policy

Below are some day care procedures that you can look for. 

List of Day Care Procedures Covered Under Health Insurance Policies

The Insurance Regulatory and Development Authority (IRDAI) has listed several daycare procedures that are covered under most health insurance plans.

  1. Dialysis
  2. Prostate
  3. Cataract
  4. Sinusitis
  5. Angiography
  6. Chemotherapy
  7. Radiotherapy
  8. Appendectomy
  9. Colonoscopy
  10. Septoplasty
  11. Sclerotherapy
  12. Liver aspiration
  13. Hydrocele
  14. Lithotripsy
  15. Piles/Fistula

Below-mentioned list includes the operations and what is included in it

Eyes

Cataract operation, removal of foreign body, corneal incision, duct operations, eyelid incision, corrective surgery for entropion, ectropion. 

Ear

Stapedotomy, stapedectomy, operations on the auditory ossicles, tympanoplasty, operations on the middle ear, reconstruction of the middle ear, incision of the inner ear, other operations on the inner ear.

Nose

Nasal sinus aspiration, operation on nasal concha, foreign body removal, other operations on the nose.

Tongue

Reconstruction of the tongue, glossectomy, other operations on the tongue.

Face

Plastic surgery to the mouth, Incisions to the mouth, jaw and face, Other operations to the mouth and face.

Skin and Subcutaneous Tissue

Skin transplantation and restoration, chemosurgery to skin, incisions to skin and subcutaneous tissue, excision of diseased skin and subcutaneous tissues.

Bones

Ligament tear and meniscus tear surgery, orthopaedics and trauma surgery, fractures and sutures on tendons, dislocation surgery, other joint and bone surgery.

Other Operations

Lithotripsy, coronary angiography, haemodialysis, radiotherapy (for cancer), chemotherapy

Further, if any surgery is performed on the digestive tract, male and female reproductive organs that are also covered.

Benefits of Daycare Procedures Covered under Health Insurance Plans

You can enjoy some of these benefits when you buy health insurance plans with daycare procedures cover:

Peace of Mind

When you know that your health insurance policy covers your treatment costs and expenses incurred for the day care treatment, it's quite a relief and you don't have to worry about your finances. 

Hassle Free Claim Process

You can opt for reimbursement or cashless claim method depending on the hospital selected and terms of the policy. 

Save Tax

On purchasing health insurance plans which offer cover for daycare procedures, you can save tax under section 80D of the Income Tax Act, 1961 for the premium paid. 

Wide Hospital Network

You can get access to a vast network of healthcare providers as these network hospitals provide you with the best medical care for you and your family even if the hospitalisation is for a brief period of time. 

What is Excluded Under Day Care Treatment?

Health insurance day care does not cover all short-term medical interventions. Treatments performed by  OPD are not considered day care treatments. 

For example, consultations for minor injuries, seasonal diseases, and regular consultations fall under outpatient care. These procedures do not require major surgical intervention and are therefore not eligible for day care treatment.

Eligibility Criteria

The eligibility comes down to three factors to be treated under day care procedure.

  1. It is necessary to undergo the procedure medically.
  2. It requires the patient to be admitted to a hospital.
  3. The procedure should require less than 24 hours because of advanced medical technology. 

Procedure to File a Claim Under Day Care Procedure

You can select a cashless or reimbursement claim settlement method based on the type of hospital selected for a day care treatment. 

Cashless Billing via Network Hospitals

Step 1 - Select a network hospital for day care  and notify your insurance company prior to admission.

Step 2 – The insurance company receives the same information from the hospital confirming that the treatment is covered under the terms  of the day care treatment.

Step 3 - The hospital receives all medical expenses from the insurance company according to the terms of the day care protocol.

Claiming Reimbursement for off-grid hospitalisation:

Step 1 – Select an out-of-network hospital and notify your insurance company prior to admission.

Step 2 - Pay all  costs associated with treatment out of your own pocket.  

Step 3 - Submit a copy of all relevant documents to request a refund.

As you look for the right health insurance plan for you and your family, be aware of what's included and what's excluded so you can tailor your insurance to your specific needs. When looking for policies that cover day care procedures, it is wise to look for policies that cover  broad categories rather than those that list specific procedures. Broader categories generally cover more surgeries and procedures and if need be you can consult an insurance advisor.

FAQs
1. What are the different factors that must be considered when choosing a daycare plan?

You can evaluate some of the factors such as co-payment, sub-limit, age limit, cashless facility.

2. Is there any health insurance plan that covers day care procedures for senior citizens?

Yes, there are many health insurance plans that offer day care treatments coverage to senior citizens as well.

3. How many day care procedures are covered by a health insurance policy in general?

The number of day care treatments covered by different insurance companies will vary. Typically, a health insurance company offers coverage for more than 100 day care treatments.

4. Do I need to additionally purchase day care treatment coverage as an add-on with my health insurance?

Not. Day care procedure is generally included in the health insurance policy as a feature hence you don't have to additionally purchase it. However it is recommended to read the terms of the policy carefully.

5. Is COVID-19 treatment part of day care procedures?

No, COVID-19 treatments are not covered under day care procedures.

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