Health Insurance

All About Day Care Procedures In Health Insurance

Dec 03, 2021

What is Day-Care Health Coverage?

There are various treatments of specific diseases and diagnostic tests which can be completed in hospitals less than/within a span of 24 hours. It does not require hospitalisation of the patient. The cost of such treatments or diagnosis of diseases is covered under the Daycare rider of the Health Insurance Policies. Expenses for diagnostic tests like MRI or some minor procedures or surgeries, wherein hospitalisation is not required and the full process can be completed within 24 hours, are borne by the Insurance companies under their daycare coverage option. These procedures also include chemotherapy, tonsillectomy, dialysis, radiation, cataract, removal of the gallbladder, etc. 

What is the need for Day-care Health Insurance?

There is a huge advancement of technology and medical sciences and certain procedures can be completed without the patient being hospitalised for less than 24 hours, but the cost of treatment by using these advanced techniques has risen manifold, thus, the introduction of the day-care rider in your health insurance policies is absolutely necessary. All the expenses that are incurred for any over-the-counter medical attention, surgeries/procedures, or diagnostic tests, which can be completed successfully within 24 hours, are borne by the Health Insurance company, by its day-care coverage. The biggest benefit of day-care coverage is that it saves you from burning a hole in your pocket by saving money in taking care of your expenses related to disease diagnostic tests and certain medical procedures.

Criteria for choosing a Health Insurance on the basis of Day-care Procedure:

Day-care coverage is provided in almost all health plans, nowadays. Some Health Insurance Companies, however, provide more lucrative benefits over others. You need to keep the following points in mind while choosing a Health Policy based on its day-care coverage:

It is advisable not to choose a plan simply by the number of procedures covered or included in the list of day-care coverage. It is always better to lay stress on the broader definition of procedures which covers a wider variety under the scope of coverage. The better is your possibility of your purpose being served, the broader the categories of procedures. For example, it is better to go for 20-25 broader categories like oncology, urology, etc which might cover a range of more than 300 diseases/surgeries than going for a list of 200 individual names of procedures.

Day-Care Procedures Included by the Health Insurance Companies:

The list of procedures which are usually covered under Day-Care coverage is as follows:

  1. Eye Treatment- Ophthalmology
    1. Operation of cataract
    2. Incision of tear glands
    3. Retinal detachment surgery
    4. Incision of cornea
    5. Excision and destruction of infected tissue of the eyelid
    6. Removal of a foreign body from the cornea, the lens of the eye, conjunctiva, etc.
    7. Procedures on the canthus and epicanthus
  2. Treatment of the Ear
    1. Removal of a tympanic drain
    2. Tympanoplasty (closure of an eardrum perforation)
    3. Reconstruction of the middle ear
    4. Reconstruction of the auditory ossicles
    5. Fenestration of the inner ear
  3. Treatment of Nose and Nasal Sinuses
    1. Surgeries or Procedures on turbinates (nasal concha)
    2. Destruction and excision of the infected tissue of the nose
    3. Nasal Sinus aspiration
  4. Treatment of the skin and the subcutaneous tissues
    1. Chemosurgery of the skin
    2. Destruction of local excision of diseased tissue of the skin
    3. Revision of skin plasty
    4. Free skin transplantation
  5. Orthopaedics (Bonus)
    1. Arthroscopic knee aspiration
    2. The incision on bone, septic and aseptic
    3. Suture and different other procedures on tendon sheath and tendons 
    4. Osteosynthesis to close the reduction of fracture, epiphysiodesis or luxation
    5. Day-Care Procedures also include heart, urinary system, cancer treatment, sexual organs in addition to the procedures mentioned above. 

Insurance Companies which cover Day Care procedures and their inclusions in such plans are: (other than the regular ones listed above)

  1. United India Health Insurance
    1. Radiotherapy
    2. Hydrocele
    3. Lithotripsy
    4. Auroplasty
  2. Star Health Insurance 
    1. Gastroenterology
    2. Neurology
    3. Oncology
    4. Urology
    5. ENT
    6. Thoracic Surgery
    7. Ophthalmology
    8. Plastic Surgery
  3. Care Health Insurance
    1. Myringotomy
    2. Stapedotomy (Treatment of different Lesions in the middle ear)
    3. Tympanoplasty
  4. SBI Smart Health Insurance
    1. Cataract Operation
    2. Tonsillectomy
    3. Cancer Chemotherapy
    4. Out-Patient Department Cover

Out-Patient Department (OPD) clause, dental and maternity expenses clause which are not included in all insurance companies, implies that if the patient is not hospitalised at least for a day, or undergoes some treatment/ surgery which is not mentioned in the list of the day-care procedures of the insurer, then the expenses for such cases will not be paid/covered by the policy. So, it is extremely important to check if the policy has an OPD clause included while choosing the plan. 

However, very few health insurance companies offer the OPD clause. Day procedures and the Out Patient Department procedures differ in the type of procedures covered under these clauses. While the former relates to the more expensive procedures which require hospitalisation at least for 24 hours, while in the latter the procedure is completed in just a few hours. For example, cataract surgery is a day-care procedure while dental treatment is taken under OPD procedure. 

The functioning of the OPD care is more like the indemnity health plans except for the scope of coverage. However, these plans also pay for dental treatment, diagnostic tests, pharmaceutical bills, consultation fees, and maternity expenses. These reimbursements depend on the sub-limits mentioned in the policy. 

Should You Opt for OPD plans?

Your expectations and needs from the policy should be the deciding factor for you to choose such plans. Maximising your tax benefits could be one of the triggers to buy OPD plans, notwithstanding the increased amount of premium for such policies. Although tax benefits together with additional coverage seem to be a lucrative option, it will be prudent on your part to make your choice considering other factors like the health insurance claim settlement record of the insurance company, the premium amount for the product, features, terms, and conditions of the plan and its benefits.

The pace of life in modern times is extremely fast and so are the expenses rising with the advancement of technologies. So, day-care coverage in your health insurance policies is extremely vital to save your money and provide you respite. You must ensure making a prudent choice in choosing a health insurance policy, which provides coverage for the most broadly categorised list of treatments.

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