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A to Z: Day Care Treatment

Zopper Team Basics of Insurance November 1st, 2023
Make day care treatment a part of your health insurance plan.

Not every medical procedure requires hospitalisation these days! In fact, day care treatments are increasingly common in India as it involves simple medical procedures that do not require 24 hrs hospitalisation. In a typical hospitalisation scenario, the bed charges tend to be around 10 to 12 percent of the average medical expenditure in private hospitals. If you do not need a hospital bed or the treatment is fairly simple and the doctors have confirmed this, you could opt for day care treatment. It would be simpler, effective and highly affordable. These days, it is no surprise that day care treatment is increasingly preferred by most patients for smaller treatment procedures. 

Day Care Treatment: What Does This Entail?

A common perception is that a person has to be hospitalised for over 24 hours to claim a health insurance policy. While this is typically true, specific treatments such as radiotherapy, dialysis, cataract surgery, colonoscopy etc., are examples of procedures that require less than a day of hospitalisation and are usually included in your health insurance plan. Therefore, pay attention to inclusions, and exclusions and check if any sub-limits exist in your policy.

Day Care Treatment: Factors To Consider

Opting for day care treatment? Here are a few factors to consider:

  1. Day care treatment is triggered by hospitalisation and medical treatment for less than 24 hours.

  2. Procedures such as some of the above-mentioned procedures are under the category of day care treatments.

  3. These procedures do not necessitate a 24-hour admission.

  4. The coverage of one plan may differ from the other. However, the IRDAI urges health insurers to include more day care covers as non-hospitalisation expenses can be more expensive.

Day Care Treatment: Benefits

A logical question you may be asking right now is “What are the benefits of Day care treatments?” Benefits vary from one plan to the other but typically it includes cashless treatment for day care treatment. An easy claims process is another key benefit.

Also, considering the well-being of the patient, day care treatment implies a quicker recovery period too.

Day Care Treatment: Common Examples

  • Cataract procedure

  • Ligament tear

However, with regard to major illnesses such as kidney failure or cancer, there may be complex treatment requirements, such as chemotherapy, etc. For other surgeries, such as coronary angiography, corrective eye surgeries, tonsillectomy, etc, the medical bills can be incredibly high. Where doctors are of the view that hospitalisation can be avoided, one can opt for day care treatment, which is affordable.

Day Care Treatment: Factors To Check Before Deciding

Remember, health insurance should be an essential component of your financial planning mechanism. It is important to check if there are any caps in your health insurance plan with regard to day care treatment. Suppose your medical bill for a day care treatment is way above the threshold sum as per your health insurance plan, you will have to pay the rest out of your pocket. Also, out-patient treatment is not covered under day care treatment. 

There is a difference between OPD treatments and day care treatments, so do not confuse the two. Unlike day care, OPD (which stands for outpatient department treatment) does not require any hospitalisation. For instance, this includes dental treatments, injuries like bleeding, fractures etc.

Several factors must be considered before you buy a health insurance plan. Consider this a basic ‘To-Do’ list to consider:

  • Pen down a checklist of essential day care procedures that are an important parameter for you. Compare it with different health insurance policies.

  • Do research and make inquiries if you are not sure about the scope of the current coverage you have, particularly with regard to day care treatment.

  • In most plans, day care coverage is provided up to the sum insured, and it also includes pre and post-hospitalisation charges.

  • Consider the rising medical expenses and opt for health insurance after analysing your requirements thoroughly.

  • Check the insurer’s premium, benefits, and claim settlement record.

  • Check the finer details of coverage based on your medical condition - for example, cataract falls within day care treatment but dental treatment comes under OPD, not day care.

Remember, day care treatment is basically about opting to have a patient  discharged from the hospital within 24 hours of admission. Important factors to consider include the doctor’s diagnosis, treatment options that are shared with you and your overall budget and insurance coverage. Once you are sure about these details, then go ahead and make a final decision.

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