Health insurance is a must-have due to the escalating costs of treatment. Furthermore, the need for the same has multiplied since the start of the Covid-19 pandemic. In India, health insurance plans are gradually becoming the norm. It ensures that one is not depleted by the costs but is provided with relief by the total or partial payment of the expenses.
At least 24 hours of hospitalisation is one of the fundamental eligibility conditions for health insurance claims. Therefore, an insurance claim is accepted if an insured person stays in the hospital for more than 24 hours after admission or passes away after 24 hours.
But What About Medical Procedures That Don't Require a Lengthy Hospital Stay? Are These Procedures Eligible for Insurance Benefits as Well?
The standard assumption when considering health insurance policies is that a stay in the hospital longer than a day is required. However, all treatments requiring extended hospital stays are no longer essential due to advancements in medical technology. Nowadays, many treatments can be administered in less than a day and don't require hospitalisation. These procedures are known as daycare treatments.
Understanding a Daycare Procedure
If finished in less than 24 hours without requiring hospitalisation, the medical operation is known as a daycare procedure. The advancement of medical research has made it feasible to treat numerous diseases more quickly than in the past. As a result, a daycare operation typically takes between 2 hours and less than 24 hours to complete. Despite being rapid, these operations have a high cost of care and must thus be reimbursed by your insurance plan.
Health insurance plans requiring less than a 24-hour hospital stay qualify for daycare coverage from insurance providers. For other claims, however, a patient must stay in the hospital for a minimum of 24 hours. Hence, it is crucial to entirely comprehend the decision-making process based on needs.
Read more - All About Day Care Procedures in Health Insurance
List of Daycare Procedures
- Nose and sinus surgery, nasal sinus aspiration, nasal concha surgery, and foreign body removal.
- Ear: Tympanoplasty, stapedectomy, surgeries on the auditory ossicles, incision of the inner ear, reconstruction of the middle ear, and other inner ear procedures.
- Eyes: Cataract surgery; corneal and eyelid incisions; entropion and ectropion correction surgery; foreign body removal; and tear duct surgery.
- Face: Cosmetic procedures involving the mouth; mouth, jaw, and face incisions; and other procedures involving the mouth and face.
- Glossectomy, tongue reconstruction, and other procedures involving the tongue.
- Bones: Fractures, sutures on tendons, orthopaedic trauma surgery, surgery for meniscus and ligament tears, dislocation surgery, and various joint and bone surgery.
- Skin and Subcutaneous Tissue: Excision of diseased skin and subcutaneous tissues, incisions to the skin and subcutaneous tissue, skin transplantation and repair, and skin chemosurgery.
- Other procedures include coronary angiography, lithotripsy, radiation (for cancer), and chemotherapy.
What is the Claim Settlement Procedure for a Daycare/24 Hours or Less Process?
Policyholders must follow the same procedure as for a typical health insurance claim when filing a claim for a daycare procedure because they are covered in many health insurance policies.
No additional requirements must be met for a health insurance claim to be settled for hospitalisation lasting less than 24 hours. The plan must cover the insured, the same as any other health insurance claim settlement process. They ought to be admitted to a network hospital that satisfies specified requirements. The claim must be filed correctly by submitting all the required documentation.
Patients should know that daycare therapies do not cover outpatient costs, including medical visits, testing, diagnostic procedures, etc. Additionally, the list of daycare procedures may differ between insurers. As a result, one needs to evaluate them accurately to proceed.
Remember that starting on July 1, 2017, 18% GST will be applied to all financial services when submitting a claim for a daycare operation. The premiums change based on several variables, including location, age, current taxes and GST.
Always Remember,
Only operations for daycare on a specific health insurance company list of covered procedures are covered. Choose health insurance plans that cover a broad range of categories over those that cover a small number of specific procedures if you're looking for health insurance that covers daycare procedures. This is because broad categories typically cover more operations and procedures in comparison.
All insurers offer coverage for daycare procedures; the only difference is that they have different lists of procedures and treatments they cover. Additionally, these therapies provide the option of cashless claim settlement. Even if you cannot use the cashless option, reimbursement for such claims is still an option.
Conclusion
It is no longer necessary to be hospitalised to qualify for health insurance in its strictest definition. As previously noted, various forms of treatment make it possible to receive medical care without going to a hospital. Therefore, procedures lasting less than 24 hours are considered daycare procedures and are covered. So be assured the next time you fear that your hospital stay will not last the required 24 hours. The daycare treatment coverage is available and would come to your aid. You can also find out the insurance company's position on treatment needed at an outpatient department and related to dental treatments in addition to the aforementioned daycare procedures. Make sure you submit a claim for the daycare procedure rather than an OPD procedure, and your health plan will handle the rest.
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