Most of us are aware that health insurance plans cover in-patient hospitalisation expenses for a wide variety of conditions and ailments, and cover pre-hospitalisation expenses as well as post hospitalisation expenses, subject (as always!) to certain limitations. However, many surgeries, once considered complex and requiring hospitalisation for more than a day, are now performed in a few hours. Termed as day care procedures, such surgeries now come under the ambit of health insurance plans. These procedures are to be distinguished from outpatient treatment – the latter being regular visits to the general practitioner or specialist for various ailments which can be treated with simple medication and not requiring hospitalisation.
There are several day care procedures now covered by health insurance plans. Procedures related to nose and sinus treatment such as excision and destruction of infected nose tissue, those related to the ear such as middle ear reconstruction, closure of ear drum perforation, orthopedic procedures such as those on the tendon or the tendon sheath, incision on bone, ophthalmology related procedures such as cataract, cornea incision, removal of foreign body from the cornea, as well as several heart and cancer related treatments now are treated as day care procedures.
Each service provider and each of their individual plans typically provide an exhaustive list of the day care procedures covered. Some cover a few procedures only while some cover several. A brief summary of some of the insurance plans with day care procedure coverage are listed below:
Niva Bupa Health Insurance Super Saver Plan
Assures coverage of all day care procedures subject to sub limits for specific conditions. Other features include cashless hospitalisation at its 4800 network hospitals, coverage of pre and post hospitalisation expenses, as well as domiciliary hospitalisation coverage. Organ donor related hospitalisation expenses are also covered. It provides coverage of hospitalisation expenses under AYUSH up to the entire SI. It also provides a No-claim bonus up to 200% of base SI. The annual premium starts at around INR 10,000/- while the SI starts at INR 5.5 lakhs up to a maximum sum insured is INR 1 crore. It also offers a lifetime renewability option and allows for an optional rider of daily cash allowance of INR 2000/- per day in case of hospitalisation. Purchase of multi-year policies attracts discounts of 7.5% on the second year’s premium and 15% on the third year’s premium.
Aditya Birla’s Activ Assure Diamond Plan
The plan offers coverage of over 586 day care procedures up to the sum insured (SI). Other features of this plan are cashless hospitalisation at their 5000 plus network hospitals, coverage of pre and post hospitalisation expenses, as well as domiciliary hospitalisation coverage up to 10% of the SI and coverage of organ donor hospitalisation expenses up to 100% of the SI. AYUSH coverage is limited and ranges from INR 15,000/- for a SI up to INR 4 Lakhs to INR 50,000/- in case of SI of INR 1 crore or more. The plan offers coverage ranging from INR 2 Lakhs to 2 crores. One of the attractive features of the plan are the Health Returns where you may be entitled to as much as a 30% discount on premium for maintaining a healthy lifestyle.
Care Health Insurance Super NCB Plan
541 day care procedures are covered. Other features of this plan are cashless hospitalisation at its 19,000 plus network hospitals, coverage of pre and post hospitalisation expenses, as well as domiciliary hospitalisation coverage up to INR 50000/- from the 4th day onwards, coverage of organ donor hospitalisation expenses up to INR 1,00,000, and coverage of hospitalisation expenses under AYUSH subject to a limit of INR 20,000/-. It also provides a no-claim bonus of 60% increase in the sum insured (SI) after two claim free years, which can go up to 150%. The annual premium starts at around INR 17,000/- for a coverage of INR 500,000/-. This plan also allows you to buy a pre-existing disease rider, which brings down the waiting period for pre-existing diseases from four years to two years.
HDFC ERGO Health Suraksha Policy
The policy also offers coverage of 144 listed day-care procedures, domiciliary treatment and in-patient hospitalisation expenses up to the sum insured even for AYUSH treatment. Other features of this plan are cashless hospitalisation at its 10,000 plus network hospitals, coverage of pre and post hospitalisation expenses, as well as domiciliary hospitalisation. The plan provides coverage of organ donor expenses as well. NCD or no-claim bonus of 5% of the basic sum insured for every claim free year, up to a maximum of 50% of the basic sum insured is also a feature of this plan. The plan is also available as a family floater policy.
Bajaj Allianz’ Health Guard
Available in two versions – Silver Plan and Gold Plan, these Health insurance plans offer coverage of up to 130 day care procedures. The total coverage under the plan ranges from INR 1.5 lakhs to INR 50 lakhs. It offers in-patient hospitalisation as well as pre and post hospitalisation coverages. Other features of the plan include coverage of organ donor expenses, daily cash benefit of INR 500/- per day up to 10 days for accompanying an insured child and reinstatement of sum insured if the cover sum, along with NCB, is exhausted.
With technological advancements in health, several procedures which required overnight hospitalisation till a few years back, now come under the ambit of day care procedures. Not all health insurance policies cover day care procedures, while some cover only a very limited number. Choosing a health insurance plan with a wide coverage of day care procedures therefore is a practical approach given the quick advances in health technology.
