What is a Day Care Treatment?

Understanding Day Care Treatment

Day Care treatments are those which involve hospitalisation for less than 24 hours. Generally, health insurance claims are settled, only if the hospitalisation is for at least 24 hours.  This, however, leads to dire strait for people who are forced to pay for treatment costs themselves, if they are not admitted to the hospital. Various daycare treatments like eye surgery, chemotherapy, radiotherapy, etc., can be done on the same day. In such cases, the policyholder may not get any benefit from the health insurance taken by him/ her.

How do Day Care Costs Affect Consumers?

According to a report in a major Indian newspaper, non-hospitalisation expenses account for twice the normal hospitalisation expenses. This is a huge amount not covered by many health insurance plans.

It is important to have daycare treatments covered by health insurance plans; that do not need hospitalisation, but cost a lot. Without a proper health insurance plan, such costs will have to be borne by the patient or his/ her family.

Do I need a Health Insurance Policy with Day Care Treatment?

As daycare treatment is not covered by all health insurance policies, it is advisable to choose a health insurance plan which covers it. Some daycare procedures like cataract surgeries, chemotherapy, dialysis, etc., can be performed on the same day. The cost of these treatments is significant enough, but you will still be required to pay for them from your pocket.

Buying a health insurance plan with daycare treatment will thus help you in saving on these costly expenses.

Now let’s look at some of the benefits of including daycare treatments in your health insurance plan.

1. No need to pay for costly daycare treatments – Including daycare treatments in the policy will help you settle the bills without any payment from your pocket. The cashless method will ensure you remain shielded from expensive treatment costs.

2. Peace of Mind – There is no hassle to arrange for money every time one visits the hospital. Most of the illnesses will be part of the daycare treatment plan included in your health insurance.

One needs to, however, read the insurance plan carefully to find out which treatments are covered in daycare. This may vary from insurer or insurer or even from plan to plan. 

Some of the major treatments included in most health insurance plans with daycare coverage are;

- Nose and Nasal sinuses
- Operations related to the ear.
- Orthopaedics – This includes fractures and treatment of tendons, tendon sheath, septic bone incisions, etc.
- Ophthalmology – The procedures include surgeries for cataracts, tear gland removal, conjunctiva, eye lens, etc.
- Treatment of skin diseases
- Cancer treatment like chemotherapy, heart-related procedures that don’t require hospitalisation etc.

Does Day Care Treatment also cover OPD (Outpatient Department) Charges?

The two treatments are different. An OPD may not necessarily be a part of the insurance plan which includes daycare treatment. 

Now let us understand the main differences between an OPD and a Day Care Treatment.

1. Type of treatment

OPD or Outpatient Department covers procedures like consultation fees, diagnostic tests, medicine bills, dental treatments, medical advice for seasonal ailments, etc., for which hospitalisation is not required. Daycare treatments, on the other hand, require hospitalisation.

2. Difference between Hospitalisation and Consultation

OPD is generally used for consultations, and hospitalisation may occur in some cases afterwards. For example, someone visits a doctor and complains about stomach aches. Medical advice will be given in this case and the patient can leave without spending any time on a specific procedure. On the other hand, if someone is undergoing chemotherapy, he/she will have to stay for some time and undergo treatment before leaving the hospital.

3. Coverage as part of the health insurance plan

Many health insurance policies do provide coverage for daycare treatment. A similar cover for OPD, however, is not provided.

4. Coverage under Sum Insured

Daycare treatments can be claimed up to the sum insured whereas OPD is generally part of a sub-limit in most cases.

5. Claim Settlement Process

Another difference is in how claims are settled for OPD and daycare treatments. Daycare treatments are settled like normal cases, cashless mostly. OPD treatments on the other hand are reimbursed. This means that one must submit the bills and necessary documents, to claim the reimbursement.

Should I Buy a Plan with both an OPD and a Day Care?

You should make this choice based on your specific needs. If you think most of your expenses are towards OPD, then buy a health policy that also includes OPD expense reimbursement.

However, if most of your expenses are towards daycare treatments, then you may focus on a policy that provides exhaustive daycare coverage.  Please bear in mind, that the cost of the policy will also increase with additional inclusions.

The premium paid though will help save taxes, as per the Income Tax Act 1961.

Some people also have queries related to nursing costs. Please note that nursing costs are reimbursed, only if they are part of the post-hospitalisation expenses and included in the health insurance. Some of the post-hospitalisation expenses that generally form a part of the coverage includes consultation fees, costs of diagnostics, medicines, etc. 

It is suggested to keep in mind all these points while buying a health insurance plan. A detailed discussion will ensure the right and appropriate coverage, without unnecessary financial burden on you.

There are plenty of health insurance plans which you can choose from. It is, however, advisable, to conduct detailed research before finalising the one, best suited to your requirements. Consider your needs and the unique needs of your family, while you buy your health insurance.

Aditya Birla Health Insurance (ABHI) keeps in mind these unique requirements of its customers while designing its health insurance plans. The motto at ABHI is “Health insurance that cares beyond financial protection.”

Aditya Birla Health Insurance has a presence in over 2300 cities in India. 

It is one of the leading and most trusted health insurance providers in the country.  ABHI also rewards its customers for their healthy lifestyle choices when they choose to buy the right health insurance plan from Aditya Birla Health Insurance.

Given below are some of the popular health insurance plans from Aditya Birla Health Insurance.  Please click on the link to get more information and select the plan that best meets your needs.

1. https://www.adityabirlacapital.com/healthinsurance/activ-assure-diamond
2. https://www.adityabirlacapital.com/healthinsurance/super-health-topup
3. https://www.adityabirlacapital.com/healthinsurance/active-health-enhanced-insurance
4. https://www.adityabirlacapital.com/healthinsurance/activ-fit