Day Care Procedures List, Benefits & Exclusions

With technological advances, many surgeries (complex and simple) can now be successfully completed in one day and the patients can be discharged from hospital within 24 hours. Such medical procedures, which do not require you to stay in the hospital for more than 24 hours are day care procedures.

What is a Day Care Procedure?

A day care procedure refers to medical treatments or surgeries that, due to technological advancements, require less than 24 hours of hospitalisation. Traditionally necessitating extended stays, these procedures now allow patients to be admitted, treated, and discharged on the same day. Examples include cataract surgery, chemotherapy, dialysis, and radiotherapy. At Bajaj Allianz, our health insurance policies comprehensively cover numerous day care procedures, ensuring you receive timely medical attention without the need for prolonged hospital stays. This coverage not only provides financial support but also offers peace of mind, allowing you to focus on your recovery.

Difference between a Day Care Treatment and OPD Treatment Cover

Aspect	Day Care Treatment	OPD Treatment Cover
Meaning	Medical treatments or surgeries that do not require an overnight stay in the hospital.	Treatments and consultations provided at the doctor’s office or outpatient clinic.
Duration	Treatment is completed in a single day, with the patient discharged on the same day.	Treatments are usually short visits, typically not requiring admission to the hospital.
Hospitalisation	No hospitalisation is required, though it may involve minor surgeries or treatments in a hospital setting.	No hospitalisation involved as it’s typically handled in outpatient clinics or doctor’s offices.
Coverage	Covered by most health insurance plans for surgeries or procedures that can be done in a day.	Typically not covered by many health insurance plans, though some policies may include OPD cover as an additional benefit.
Cost	Insurance often covers day-care treatments fully, subject to terms and conditions.	OPD visits often incur out-of-pocket costs unless specifically covered in the health plan.
Examples	Cataract surgery, chemotherapy, dialysis, endoscopy.	Routine check-ups, vaccinations, diagnostic tests, prescription medications.

Inclusions of Day Care Procedures

Health insurance policies cover a wide range of day care treatments, which are medical procedures that require hospitalisation but do not need a 24-hour stay. Thanks to medical advancements, treatments that once required prolonged hospitalisation can now be completed within a few hours. These include surgeries, diagnostic procedures, and specialised therapies. Unlike outpatient treatments, day care procedures are covered under most health insurance plans, ensuring financial protection for policyholders. However, coverage may vary across insurers, so it’s essential to check the specific inclusions before purchasing a policy.

Category	Examples of Treatments
Eye Care	Cataract Surgery, Retinal Laser Treatment, Corneal Repair
ENT (Ear, Nose, Throat)	Sinus Surgery, Tonsillectomy, Ear Drum Repair, Nasal Polyp Removal
Orthopaedic	Arthroscopy, Ligament Repair, Fracture Treatment
Cancer Care	Chemotherapy, Radiotherapy
General Surgeries	Hernia Repair, Varicose Vein Treatment, Gallbladder Stone Removal

To facilitate our customers with the best-in-class services, we at Bajaj Allianz offer coverage for most day care procedures across our various health insurance plans. There is a widespread myth that day care procedures are not covered under health insurance, with many believing that only longer hospitalisations are included. However, with advancements in medical treatments, the duration of procedures has decreased significantly, prompting health insurance policies to evolve and cover these short-term hospitalisation treatments. While day care treatments are generally covered, it’s important to note that outpatient procedures (OPD), such as routine consultations or minor dressings, are typically not included in the coverage. Therefore, always review your health insurance policy to understand the full scope of what’s covered and ensure that it meets your healthcare needs.

Factors to be Considered When Choosing a Day Care Plan

When selecting a day care health insurance plan, it's essential to consider several key factors to ensure comprehensive coverage and financial protection. 1. Co-payment Clause: This clause specifies the percentage of the claim amount that the policyholder must pay out-of-pocket. Opting for a plan with a lower co-payment percentage can reduce your financial burden during claims. 2. Sub-limits: Some policies impose sub-limits on specific treatments or procedures, capping the amount payable. It's advisable to choose a plan with minimal or no sub-limits to ensure adequate coverage for various treatments. 3. Age Limit: Health insurance policies often have age restrictions for coverage. Ensure the plan accommodates your age group and offers coverage for day care procedures relevant to your age. 4. Cashless Facility: A cashless facility allows you to receive treatment without immediate payment, with the insurer settling the bill directly with the hospital. Confirm that your chosen plan offers this facility at a wide network of hospitals. 5. Network Hospitals: Verify that the insurance provider has a robust network of hospitals, especially those near your location, to facilitate easy access to cashless treatments. 6. Pre- and Post-Hospitalisation Coverage: Check if the policy covers medical expenses incurred before and after hospitalisation, as these can add up significantly. 7. Waiting Period: Be aware of the waiting period for specific treatments or pre-existing conditions. Opt for plans with shorter waiting periods to ensure timely coverage. 8. Claim Settlement Ratio: Research the insurer's claim settlement ratio to assess their reliability in processing and settling claims efficiently. 9. Premium Amount: While lower premiums are attractive, ensure they align with the coverage and benefits offered. Balance affordability with comprehensive coverage. 10. Exclusions: Thoroughly review the policy exclusions to understand what is not covered, preventing surprises during claims. By carefully evaluating these factors, you can select a day care health insurance plan that best fits your healthcare needs and financial situation.

Benefits of Inclusion of Day Care Procedures in Health Insurance Policies

Following are the advantages of day care procedures being included in health insurance:

1. Peace of Mind

Getting admitted in a hospital even for a day causes stress. And the heavy cost of treatment can definitely add to this. But, knowing that your day care expenses will be taken care by your insurance company can relieve you from this stress and give you the required peace of mind.

2. Cashless Service

If you know in advance about a surgery (day care procedure) that you or your family member will be undergoing, then you can check with your health insurance company and avail the benefit of cashless health insurance  claim settlement for the listed day care procedures in your health insurance policy.

3. Tax Saving Benefit

In India, you get the benefit of tax exemption under section 80D of the Income Tax Act for paying a premium towards your health insurance policy. So, a policy which covers you and your family for day care procedures can give you an added tax saving benefit.

4. Best Medical Care

You can get the treatment for day care procedures in the network hospitals, where you get the best medical care with an added advantage of cashless service. Treatment in a network hospital can ensure that you and your family members get quality treatment, even if the hospitalization is for a short period of time.

5. Health CDC Benefit

Health CDC (Click by Direct Claim) is a unique feature provided by Bajaj Allianz in our Insurance Wallet app, which allows you to raise and settle claim up to INR 20,000 quickly and conveniently.

Exclusions of Day Care Procedures

OPD (Out-Patient Department) treatments such as dental clean-up are not covered under day care procedures and your health insurance company will not reimburse you for the same. Most plans cover day care procedures but not OPD hence it is important to browse through exclusions in health insurance policies to ensure that you do not file claims for treatments that are not covered. We recommend that you read the policy wordings carefully and understand which day care procedures are covered in your health insurance policy. Please discuss with your insurer about the inclusions and exclusions regarding the same so that you do not face any trouble while filing a claim for day care procedures against your health insurance policy. Also Read - Family Floater Health Insurance

Conclusion

Day care procedures, which allow patients to receive treatment and return home within 24 hours, are increasingly covered by health insurance policies. The inclusion of such procedures brings numerous benefits like peace of mind, cashless services, tax savings, and access to high-quality medical care. However, it’s important to be aware of exclusions, such as OPD treatments, and to carefully review your policy to ensure comprehensive coverage for day care procedures. Always consult with your insurer to understand what is included and avoid issues when filing claims.

FAQs

What are day-care procedures?

Day-care procedures are medical treatments or surgeries that do not require an overnight stay in the hospital. They are typically short, minimally invasive, and allow the patient to return home the same day.

Is endoscopy a daycare procedure?

Yes, endoscopy is considered a day-care procedure. It is a non-invasive diagnostic procedure that generally does not require an overnight stay in the hospital.

What are day-care expenses?

Day-care expenses are the costs incurred for medical treatments or procedures that are completed in a single day, including consultations, diagnostics, and minor surgeries. These costs are typically covered under many health insurance plans. * Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.