Day Care Treatment - List of Procedures Covered in Health Insurance

What is a Day Care Treatment?

A few years ago, a surgery or medical procedure that used to need a long hospital stay, due to technological and healthcare advancement, may now be finished within 24 hours. This is known as a day care operation. Due to this, a patient does not stay in a hospital for the required minimum of 24 hours before filing a claim.
Day care treatments are operations or procedures that are not executed over an extended period of time in the hospital. However, this does not mean the cost of these treatments is cheap. In fact, after calculating the cost of prescription drugs and medical testing, the price of these operations may end up being quite expensive.
Keeping this situation in mind, health insurance companies have made it possible for policyholders to file a claim in the event they have to undergo such a procedure, thus bypassing the 24 hour hospitalization rule.

Benefits of Including Day Care Treatment in Health Insurance

Launch Date Beneficiaries under the Scheme Coverage Amount Official Website Official Website Below are few of the benefits of having day care treatment included in your health insurance policy:

Easy access to healthcare: Day care procedure coverage helps in getting access to quality medical care without having to worry about treatment expenses.
Easy claim process: A policyholder can file a reimbursement or cashless claim method based on the hospital selected and terms of the policy.
Huge healthcare network: Policyholders get access to a vast network of healthcare providers, which makes timely and quality healthcare available.
Tax savings: A health insurance policy allows policyholders to attain tax benefits based on the amount paid as the insurance premium.

Day care treatment: What is covered?

Day care treatments coverage in medical insurance offers healthcare expenses related to any surgery, treatment, or operation that requires the policyholder to spend less than 24 hours in a hospital. A few examples of day care treatments include eye surgery, dialysis, chemotherapy, and any illness or injury that requires you to spend only a few hours at a day care center.

What is not covered under day care treatment?

Under a health insurance, a day care treatment doesn’t cover you for all short-term medical procedures. Treatments managed by the Outpatient Department (OPD) are not considered as day care procedures. For example, medical consultation for minor injuries, seasonal illness, and regular consultations are considered under OPD. Such procedures don’t require any major surgery, hence are not covered as day care treatments.

Reasons for Buying Best Health Insurance in India

It is a cruel reality that no matter how healthy or fit you are, you will need medical treatment or a doctor’s advice at some point in your life. Here are a few points you need to remember about health insurance:

The medical costs in the country and around the world are consistently rising. Even regular medical tests can cost you a significant amount of money. Your salary alone cannot cover these expenses nor should you take up so much financial burden on yourself. In worst cases, you may have to use your savings on hospital bills.
Diseases are no longer age-specific. The environmental damages, habit of processed food, and a hectic lifestyle have led to various kinds of illnesses in people of all ages.
Health insurance helps you cover medical treatment costs, pre and post-hospitalisation expenses, ambulance costs, critical illnesses, medicines or surgery expenses, and a lot more. The best health insurance also provides benefits like cashless hospitalization at network hospitals.
A health insurance policy also helps you to save money by enabling you to save taxes under Section 80D of the Income Tax Act, 1961.

How to Make a Claim for Your HDFC ERGO Health Insurance

The sole purpose of buying a health insurance plan is to get financial support at the time of medical emergency. Hence, it is important to read the below steps to know how Health Insurance claims process works differently for cashless claims and reimbursement claim requests.

Cashless Claim
Reimbursement Claim

Health Insurance Cashless Claims get approved within 20*~ minutes

Fill pre-auth form for cashless approval

1

Intimation

Fill up the pre-auth form at the network hospital for cashless approval

2

Approval/Rejection

Once hospital intimates us, we send you the status update

3

Hospitalisation

Hospitalisation can be done on the basis of pre-auth approval

medical claims settlement with the hospital

4

Claim settlement

At the time of discharge, we settle the claim directly with hospital

We settle reimbursement claimswithin 6~* hours

1

Hospitalisation at non network hospital

You need to pay the bills initially and preserve the original invoices

2

Register a claim

Post hospital discharge send us all your invoices and treatment documents

3

Verification

We verify your claim related invoices and treatment documents

4

Claim Settlement

We send the approved claim amount to your bank account.

Things to consider while buying Day Care health insurance coverage

Some of the critical illnesses covered under PMJAY are as follows:

Sum insured: Ensure that the total sum insured is enough to cover your day care treatment requirements.
Inclusions and exclusions: Read the policy document carefully to understand what treatments are included and what treatments are excluded from the day care procedure as per your insurance provider.
Network hospitals: Check the list of network hospitals to shortlist all nearby hospitals to easily avail the cashless claim facility.

What is the difference between a Day Care Procedure and OPD?

Features	Day Care Treatment	OPD Treatment
Hospitalisation	Less than 24-hour hospitalisation is required	Hospitalisation is not required
Coverage	To the extent of total sum insured	Coverage up to a limited sum based on the insurer.
Procedures	Cataract surgery, angiography, chemotherapy, etc.	General medical consultation for seasonal illness, health checkups, minor injury etc.

FAQs on Day Care Treatment

1. Is day care coverage included in my health insurance or do I need to purchase it separately?

You don’t need to buy for day care treatment coverage separately. It comes included in the health insurance as a feature, depending on the policy terms.