Day Care Treatment

Day care treatment is a medical treatment or procedure where a patient is discharged from the hospital within 24 hours of admission. Such procedures are usually either non-invasive or minimally invasive. Health insurance plans covering day care treatments may cover almost all expenses related to the procedure. This includes nursing, room charges, consultation fees, anaesthetics, medicines,  post-hospitalisation expenses, and more.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

People often tend to confuse day care treatment with OPD consultations. However, it is essential to understand that not all short-term medical treatments are regarded as day care procedures. Here, day care refers to treatments, surgeries, and operations where you need to be hospitalised for less than 24 hours.

 

When hospitalisation and treatment procedures exceed the 24-hour timeline, the expenses for the same are covered under hospitalisation costs in your health insurance plan. On the other hand, smaller medical consultations such as fractures, sprains, etc. are covered under OPD benefits.

Check out these health insurance plans that offer a wide range of features along with day care treatments. The table below gives a quick insight into the features and premiums of some of these plans.

You must read your health insurance policy document carefully to know about the scope of coverage in day care procedures. Here are a few standard things that are covered in the day care treatment. 

All expenses related to your medical care will be fully covered, from room and board to nursing fees, as well as the charges of surgeons, consultants, specialists, and anesthesiologists. Additionally, the costs of essential medical items such as prosthetic devices, medications, orthopaedic implants, vascular stents, X-rays, medical reports, surgical appliances, and operation/theatre charges are included in your health insurance coverage for day care treatment.

The cost of hospitalisation is rising especially amid the rising cases of pandemic and health concerns. Hence, it is essential that you have all-round health insurance coverage to skip medical expenses from your pocket. day care treatments can be quite financially exhaustive. Hence, there are several reasons why you must not skip on this cover: 

• Non-hospitalisation Expenses

In some cases of illness, the cost of non-hospitalisation can surpass the cost of treatment. So, in such a case, if you do not have day care treatment in health insurance, you may have to spend a lot from your pocket.

• Overall Treatment

Certain illnesses and diseases like cancer or organ failures can include a long day care procedure and it can heavily impact the overall bills of your treatment. So, why pay from your end when your insurance provider is here to cover the cost?

• Quick Treatment

Not all illness conditions need long hospitalisation. Some of these can be treated within 24 hours. Since most health insurance plans allow claims only if the hospitalisation exceeds 24 hours, it is essential to have a cover of day care treatment in health insurance. It helps you save medical expenses even if you do not have to be hospitalised for less than 24 hours.

If you are planning to purchase the best health insurance policy, always remember to have a policy that includes day care procedures. It can provide you with the following benefits:

• Exceptional Medical Care

Accessing top-tier medical care becomes effortless with day care treatment coverage. You can access cutting-edge medical procedures at a vast network of accredited hospitals. These facilities boast proficient medical personnel and staff dedicated to delivering exemplary services.

• Seamless Cashless Claims

Day care procedures within your health insurance policy offer vital financial support during critical times through cashless health services. By informing your insurer about your procedure in advance and obtaining pre-approval, you can receive treatment without the need for immediate payment. The insurer will directly settle the medical bills, alleviating financial burdens.

• Tax Benefits

Opting for a health insurance policy with day care procedure coverage can yield additional tax benefits. Premium payments towards your policy qualify for deductions under Section 80D of the Income Tax Act, 1961, providing you with potential savings.

• Health CDC Benefit

Claim by Direct Click (CDC) is a standout feature available on marketplaces like Bajaj Markets. This innovative app-based service streamlines the claims process for amounts up to ₹20,000, ensuring hassle-free transactions. Utilising the insurance wallet app, you can swiftly submit the necessary details. These include the discharge date, estimated expenses, diagnosis, and treatment information, resulting in prompt transfer of your claim amount.

• Peace of Mind

Amidst medical treatments, the last thing you need is added stress. With assured quality treatment at accredited network hospitals and financial support, you can undergo procedures with absolute peace of mind, free from worries and uncertainties.

Most health insurance plans offer day care treatment as part of their coverage. However, the nature of the diseases or ailments covered differs from insurer to insurer. On the other hand, treatments such as cosmetic/beautification surgeries and certain dental surgeries are not typically covered.

The eligibility criteria for treatments under the day care procedure cover come down to 3 factors:

• The procedure must be medically necessary

• The patient must be admitted to the hospital for this treatment

• The medical procedure/treatment should take less than 24 hours

The process to raise claims on day care procedures is the same as raising claim requests on hospitalisation expenses. Your insurer will process the day care treatment claim as a part of your health insurance cover. Let’s understand the steps to raise cashless and reimbursement claims:

• Cashless Claim via Network Hospitals

1. Go to the nearest network hospital for your day care treatment and inform the insurance provider about the procedure before being hospitalised

2. The hospital shall share the same information with your insurer to confirm that the treatment comes within the terms and conditions of their day care procedure coverage

3. Once the procedure is done, the hospital shall receive all medical payments from the insurer based on the terms of your insurance coverage

• Reimbursement Claims via Non-Network Hospitals

1. Choose a non-network hospital for the procedure and inform your insurer about the hospitalisation

2. Pay all the required treatment-related costs from your own pocket

3. Submit a soft copy of important documents to raise a reimbursement claim for day care treatment

Here are a few things you must keep in mind before availing the day care treatment:

• The treatments covered under OPD benefits are different from day care treatments in health insurance. So, while a dental clean-up is covered under OPD, dental insurance are covered under the day care procedures. Knowing the difference between the two will help you raise the right claim request with your insurer.

• Avoid buying a health insurance plan solely based on the day care procedures covered under the policy. Go through the fine print of your health insurance document and get your queries resolved before signing the deal.

• You must always remember to submit the original documents of your prescription, medical reports, etc. to the insurance company. If you fail to submit the required documents while filing a claim, it can result in rejection.