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What Day Car Procedure is Covered in Health Insurance?

Due to the technological advancements in medicinal industry, a host of surgeries and procedures that earlier required prolonged or at least a day’s hospitalisation can now be completed in less than 24 hours. This short-term hospitalisation procedure is called a ‘Day Care Procedure’.

A common assumption is that standard health insurance policies only cover expenses incurred towards expensive treatments pertaining to critical illnesses, requiring an extended hospital stay. However, the fact is that most health insurance providers cover day care procedures as well.

Some health insurance providers cover limited day care procedures, others cover almost all day care procedures. Day care procedures include cataract, radiotherapy, chemotherapy, dialysis, angiography, tonsillectomy, lithotripsy, etc.

The list of the exact day care procedures covered is included in the insurance policy documents and can be found on the company’s website as well. The list of day care procedures is likely to grow in the near future.

Advantages of Day Care Health Insurance

Despite the fact that most day care procedures do not require extended hospitalisation, they still turn out to be expensive. Even over-the-counter expenses like diagnosis tests not requiring hospitalisation/treatment can cost a bomb. This is where day care health insurance saves the day.

Example 1: Mr. Verma was diagnosed with kidney stones and a specialist advised lithotripsy for the stones’ removal. Earlier, the patient needed to be hospitalized to undergo this surgery. But due to medical advancements, this surgery now lasts only for a few hours and the patient is discharged the same day.

Mr. Verma holds a health insurance policy that includes cover for day care procedures. He scheduled the surgery for a later date and took the necessary steps to avail cashless services. The cashless payment procedure was smooth and Mr. Verma’s health insurance provider approved the treatment costs without any hassles, as lithotripsy was covered under the insurance company’s listed day care procedures.

Example 2: Mr. Singh met with an accident and required a Septoplasty (surgical procedure to correct nasal septum displacement). The surgery expenses worked out to a whopping INR 60, 000 Mr. Singh underwent the Septoplasty surgery successfully and went home the very same day. Thanks to the day care insurance cover in his health insurance policy, he was able to pay for the Septoplasty without any financial stress.

How to Choose Day Care Health Insurance Plan?

Most health insurance companies highlight the “number” of day care procedures covered under their policy to entice customers. As a result, novice health insurance buyers wrongly choose a health insurance plan with maximum day care procedures.

However, the number of day care procedures listed in the medical insurance plans is not the only factor that one must consider before investing. Cashless facility, age limit, sub limit, co-pay, etc. all play an important role in a health insurance policy.

Your health insurance advisor’s advice, and visiting the website of dedicated brokers and asking for expert opinions could aid in buying a health insurance plan best suited to your requirements.

Quality Vs. Quantity

It is advisable to see the treatments covered under the day care procedures in a broader ‘concept’ sense. For instance, instead of looking at 200+ names of various isolated surgeries, looking at 20-30 broader categories like urology, oncology, etc.is a more practical, beneficial and inclusive approach, as hundreds of procedures are covered under these broad umbrellas.

Moreover, for all practical purposes, it is better to opt for the broader categories that even a layperson can understand. Further, an insurance company that gives a detailed list with specific procedures may refuse to cover new treatments that come up in future due to medical science advances.

When comparing different plans with similar features and benefits, it is wiser to opt for the one with broader categorization or better yet, with all-inclusive day care procedures.

Category Cover

Public sector insurers usually list out the broad categories of day care procedures. The advantage is that if a particular category of day care procedure is not listed at the time of policy purchase, one can request for its inclusion to third party administrators prior to treatment commencement.

Process of Filing Day Care Claims in Health Insurance

The process for filing day care claims is similar to that of a regular health insurance policy, since day care procedure coverage is an in-built policy feature. In case of planned procedures, the cashless route can be availed - some companies need prior intimation.

In other cases, insurers reimburse after submission of the required documents. The provisions for pre and post hospitalisation benefits also remain same - the insurance company reimburses hospitalisation expenses incurred by the policyholder.

Some Treatments Included in Day Care Procedures

Type of treatment

Details

Nose, nasal sinuses

Procedures on the turbinates, Excision and destruction of infected tissue of the nose, Nasal sinus aspiration

Ear operations

Reconstruction of the middle ear, Reconstruction of the auditory ossicles, Fenestration of the inner ear, Removal of a tympanic drain, Tympanoplasty (eardrum perforation closure)

Orthopedics

Arthroscopic knee aspiration, Osteosynthesis, Incision on bone - aseptic and septic, Suture and other procedures on tendons/tendon sheath

Opthalmology

Cataract, Excision and destruction of infected tissue of the eyelid, Incision of tear glands, Incision of the cornea, Retinal detachment surgery, Procedures on the epicanthus and canthus, Foreign body removal from the cornea, conjunctiva, eye lens, etc.

Treatment of subcutaneous tissues and skin

Free skin transplantation,Chemosurgery to the skin, Revision of skin plasty, Local excision or destruction of diseased tissue of the skin

Day care procedures also include heart and cancer treatments, urinary and sexual organs.

* The above list is indicative. Policies offered by different insurance companies may have specific inclusions and exclusions.

Outpatient Department (OPD), Dental and Maternity Covers

Some insurance companies offer policies where the USP is the coverage of outpatient department (OPD), maternity, and dental expenses. These policies cover treatments not requiring 24-hour hospitalisation nor forming a part of the day care procedures list.

The primary difference between OPD and day care procedures is the nature of the procedures covered. While OPD includes minor medical expenses, the latter relates to costlier procedures that otherwise would have entailed at least 24-hour hospitalisation, if not for medical technology advancements. Dental treatments fall in the OPD category, while a cataract surgery comes under day care procedures.

Not too many OPD products are available in the Indian market as of today. Apollo Munich, ICICI Lombard, Star Health, and Bajaj Allianz are some companies offering these kinds of plans.

Some Insurance Companies offering Day Care Procedures

Company

Day care procedures covered

SBI Smart Health Insurance

Chemotherapy, Tonsillectomy, Cataract

United India Health Insurance

Radiotherapy, Lithotripsy, Hydrocele, Auroplasty

Star Health Insurance

Oncology, Neurology, Urology, Ophthalmology, Plastic Surgery, Thoracic surgery, Gastroenterology, ENT

Religare Health Insurance

Stapedotomy, Tympanoplasty, Myringotomy


Now it’s Your Turn!

In today’s day and age marked by growing medical inflation, day care procedures health cover is imperative as it helps avoid unnecessary financial burden. So do well to opt for a health insurance company that covers a broad range of day care treatments.