What Day Care Procedure is Covered in Health Insurance?

Day care procedures are surgeries or procedures that do not require hospitalization for 24-hours. Thanks to the advancement in the field of medicine and technology. 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.

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    However, there are Some health insurance providers cover limited day care procedures, while some may cover all the day care procedures. These include cataract, radiotherapy, chemotherapy, dialysis, angiography, tonsillectomy, lithotripsy, etc.

     

    The list of all the day care procedures covered is given in the insurance policy documents and can also be found on the company’s website.

    Some Treatments Included in Day Care Procedures

    Type of Daycare Ttreatment

    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.

    Some Insurance Companies offering Day Care Procedures

    Below is the table with Health Insurance companies who are offering coverage for Daycare procedures in 2021:

    Insurance Companies

    Day Care Procedures

    Aditya Birla Health Insurance

    586+

    View Plan

    Bajaj Allianz Health Insurance

    130+

    View Plan

    Bharti AXA Health Insurance

    Covered

    View Plan

    Cholamandalam Health Insurance

    141+

    View Plan

    Digit Health Insurance

    Covered

    View Plan

    Edelweiss Health Insurance

    Covered

    View Plan

    Future Generali Health Insurance

    Covered

    View Plan

    IFFCO Tokio Health Insurance

    161+

    View Plan

    Kotak Mahindra Health Insurance

    Covered

    View Plan

    Liberty Health Insurance

    405+

    View Plan

    Max Bupa Health Insurance

    Almost all day-care treatments covered

    View Plan

    Manipal Cigna Health Insurance

    Covered

    View Plan

    National Health Insurance

    140+

    View Plan

    New India Assurance Health Insurance

    N/A

    View Plan

    Oriental Health Insurance

    Covered

    View Plan

    Religare Health Insurance

    540+

    View Plan

    Raheja QuBE Health Insurance

    Covered

    View Plan

    Royal Sundaram Health Insurance

    200+

    View Plan

    Reliance Health Insurance

    No-limit

    View Plan

    Star Health Insurance

    Covered

    View Plan

    SBI Health Insurance

    142+

    View Plan

    Tata AIG Health Insurance

    541+

    View Plan

    United India Health Insurance

    140+

    View Plan

    Universal Sompo Health Insurance

    Covered

    View Plan

    See More Plans

    Disclaimer: *Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

    Advantages of Day Care Health Insurance

    Despite the fact that most day care procedures do not require hospitalization of 24-hours or more, they can still be expensive. Even over-the-counter expenses like diagnosis tests 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 surgical procedure can now be completed in few hours and the patient gets discharged on the same day.

    Mr. Verma holds a health insurance policy that covers day care medical 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 underwent the Septoplasty surgery successfully and was discharged 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 a 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 while selecting health insurance policy.

    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-hospitalization benefits also remain the same - the insurance company reimburses hospitalization expenses incurred by the policyholder.

    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 hospitalization 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 hospitalization, if not for medical technology advancements. Dental treatments fall in the OPD category, while cataract surgery comes under day care procedures.

    Now it’s Your Turn!

    Amid the growing medical inflation and COVID-19 pandemic, coverage for day care procedures in health insurance is imperative in reducing the unnecessary financial burden. So do well to opt for a health insurance company that covers a broad range of day care treatments.

    Written By: PolicyBazaar - Updated: 30 June 2021
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    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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