Day Care Treatment in Health Insurance

What is Day Care Treatment in Health Insurance? Day care treatment in health insurance means medical procedures or surgeries that don’t need you to stay in the hospital overnight. They are done in a hospital or a registered day care center. These treatments use general or local anesthesia and are finished within 24 hours. Earlier, such procedures required longer hospital stays, but now they are quicker because of better medical technology. Examples include cataract surgery, dialysis, and chemotherapy.

Just because your procedure is short doesn’t mean your claim will be smooth. Most policies today include day care treatment by default, but you’ll still need to navigate sub-limits, exclusions on non-mandatory treatments, and pre-authorization requirements.

While IRDAI mandates coverage for all procedures that meet its definition of day care, execution still varies across policies, from how transparently terms are explained to how easily claims are processed.

At Ditto, after reviewing 200+ plans, we’ve found that clarity and usability still differ widely. In this article, we’ll break down how day care treatment in health insurance works, what’s included, what’s not, what to look for in a policy, and the best plans that offer strong support.

Still unsure if your health insurance covers the proper daycare procedures?

Please don't leave it to guesswork. At Ditto, we help you understand what your policy covers — no jargon, no pressure. And if you're buying a new plan, we'll handpick one that fits your needs and budget. 

Talk to an advisor — it’s free, honest, and zero spam. Book your free call now

Best Health Insurance Plans Offering Day Care Treatment Coverage

When it comes to health insurance, almost every modern plan includes day care procedures by default. But that doesn’t mean all plans offer the same quality of coverage. Some quietly limit what you can claim through room rent restrictions, co-payments, or sub-limits on advanced treatments like robotic or laser surgery.

So if you're comparing policies for day care support, it’s not about whether it’s covered, but how well it’s covered. The plans below stand out because they offer full-sum insured coverage for day care, with no hidden caps, no co-pays, and top-tier features across the board.

Health Insurance Plan	Day Care Coverage	Room Rent Limit	Disease-wise Limits	Copayment	Restoration	Pre & Post Hospitalization coverage
HDFC Ergo Optima Secure	Covered up to Sum Insured	Any Room	NA	NA	100% once per policy period (add-on : unlimited)	60 & 180 days
Aditya Birla Activ One Max	Covered up to Sum Insured	Any Room	NA	NA	Unlimited after 1st claim	90 & 180 days
Care Supreme	Covered up to Sum Insured	Any Room	NA	NA	Unlimited times	60 & 180 days
Niva Bupa Aspire Titanium+	Covered up to Sum Insured	Any Room	NA	NA	Unlimited after 1st claim	60 & 180 days
ICICI Lombard Elevate	Covered up to Sum Insured	Single Private Room (upgradable with an add-on)	NA	NA	Unlimited times	90 & 180 days

Now that you have taken a glance at the best health insurance plans with daycare coverage, let's talk about what day care in health insurance means, why it is important, and how it can make a real difference during claims.

What Exactly Qualifies as Day Care Treatment?

The IRDAI defines day care treatment as any medical or surgical procedure that:

• Is undertaken under general or local anesthesia,
• Requires hospitalization infrastructure,
• Is completed in under 24 hours due to medical advancement,
• And would otherwise have required inpatient care beyond 24 hours.

Friendly reminder: Outpatient consultations or diagnostic-only procedures are not considered day care.

Under IRDAI’s guidelines, any procedure that meets this definition must be covered, even if it’s not explicitly listed in the insurer’s brochure or policy document.

So what’s the point of all those long day care lists with 100, 400, sometimes even 600+ procedures?

They’re mostly a legacy from when day care treatment wasn’t a mandatory benefit. Today, these lists are just reference guides, not hard limits. If your treatment meets the IRDAI’s definition, it qualifies, regardless of whether it appears on a list or not.

How Does Day Care Treatment in Health Insurance Work?

Let us walk you through how day care treatment works with our client scenario to make things easy to understand.

A 38-year old customer started having recurring pain in his knee. After a few tests, the doctor recommended an arthroscopic procedure, a minimally invasive surgery to clean up damaged cartilage. The good news? It's a day care treatment in health insurance that only takes a few hours to perform before you’re sent back home on the same day.

Step 1: The first step is to verify if the procedure qualifies as a day care treatment under health insurance.

You have to check for the following:

• Requires anaesthesia?
• Done in a hospital setup?
• Doesn't need 24+ hours of hospitalisation?
• Does it meet IRDAI’s day care definition (even if not on a list)?

So, yes, this is a textbook day care treatment in health insurance, and his health plan covers it.

Step 2: The next step is planning the treatment

Since it's not an emergency, the customer planned the surgery for a later date. Here's what he did next:

• Informed the insurer in advance through his insurer's TPA (third-party administrator) or via the hospital's insurance desk.
• Got pre-authorisation for cashless treatment at a network hospital.
• Showed up on the day of surgery with his health card and ID. The hospital handled the rest.

His insurer approved the cost before the procedure began. No out-of-pocket payment needed, except for minor consumables (which are also covered nowadays in comprehensive plans, like the ones mentioned above).

But What If It Was an Unplanned Daycare Surgery?

Let's say the same client had a sudden eye injury and needed corneal surgery (also a day care procedure, done the same day). He didn't have time for pre-authorisation.

No problem.

In that case:

• He would still get the treatment at a registered hospital.
• He'd just have to pay the bill upfront.
• Then, file for reimbursement after discharge with all the documents (discharge summary, surgeon's notes, bills, prescriptions, etc).

As long as the procedure meets the IRDAI definition for day care treatment, the insurer is obligated to cover it, even if it’s not on their published list.

Key Things to Know:

• If it's planned and at a network hospital, always go for cashless.
• If it's unplanned or at a non-network hospital, reimbursement works just fine. Just keep your paperwork in order. But if it’s an emergency at a network hospital, you might still be able to get cashless approval, as long as you inform the insurer immediately.

Cashless vs Reimbursement Claims in Day Care Treatment: At a Glance

Step	Cashless	Reimbursement
Hospital type	Network only	Any registered hospital
Pre-auth needed?	Yes (24–48 hrs before)	Not required
Upfront payment	Only for excluded items	Full payment upfront
Claim method	Handled by hospital & insurer	You submit docs yourself
Processing time	Instant to 48 hrs	7–15 days post submission

Ditto's Take: Day care treatment in health insurance is far more common than full hospital stays, and they're often expensive. Having solid day care coverage means your insurance works for the kind of care you'll need. Just make sure you know what's covered, where to go, and how to claim, and you're sorted.

Now, if you're wondering what treatments typically fall under daycare, here's a quick list.

Common Day Care Treatments Covered by Health Insurance (Non exhaustive)

• Cataract surgery
• Tonsillectomy (removal of tonsils)
• Dialysis (for kidney-related issues)
• Chemotherapy and radiotherapy (for cancer treatment)
• Lithotripsy (for kidney stone removal)
• Sinus surgery
• Nasal polypectomy (removal of nasal polyps)
• Septoplasty (to correct a deviated nasal septum)
• Corneal transplant
• Arthroscopic procedures (like ligament repairs)
• Hernia repair surgery
• Angiography (diagnostic heart test)
• Biopsies (like liver or prostate)
• Hydrocele surgery
• Varicose vein treatment
• Ear surgeries (like tympanoplasty)

Of course, just like with everything in insurance, there are exceptions. Let's see what those are.

What Day Care Treatment in Health Insurance Usually Doesn't Include

• Outpatient consultations (like just visiting a doctor without any procedure)
• Diagnostic tests only (e.g., blood tests, X-rays, MRI — unless part of a covered procedure)
• Dental treatments (unless due to an accident and specifically covered)
• Cosmetic or plastic surgery (unless medically necessary)
• Fertility or IVF-related treatments
• Experimental or unproven procedures
• Even if your insurer shares a specific list of day care procedures, coverage depends on whether the treatment fits the IRDAI definition; not whether it appears on that list.
• Non-medical expenses (like registration fees, admission charges, toiletries, etc.)
• Pre-existing conditions (unless the waiting period is over)
• Treatment at non-registered facilities (must be a hospital or registered day care center)

Always check the fine print or consult with your advisor to ensure accuracy. What appears to be a "quick" treatment may still not qualify as daycare in health insurance. 

That's why it's essential to know precisely what your policy says about daycare treatments.

What Should I Look for in the Day Care Coverage Clause While Buying Insurance?

Before you sign the dotted line, here's what you really need to check in the day care clause:

1. Don’t be misled by long procedure lists

Some insurers still highlight large day care lists (400+), but per IRDAI, any procedure that meets the definition must be covered, whether it’s listed or not. Such lists were more relevant in the past, when day care coverage wasn’t standard. Today, they’re just for reference and shouldn’t influence your decision.

What to look out for: Focus on whether the insurer clearly follows IRDAI’s definition-based approach. If they rely solely on a fixed list without explanation, or can’t confirm how they assess day care claims, it’s a reason to dig deeper.

2. Specific Inclusions and Exclusions

Not all day care coverage is created equal. Some policies include only surgical procedures, while others also cover non-surgical treatments like chemotherapy, radiotherapy, or dialysis. At the same time, many insurers exclude diagnostics or outpatient (OPD) care, even if it's done in a hospital setting. This can lead to confusion, especially if you're relying on the policy for a planned treatment.

IRDAI allows insurers to define specific inclusions and exclusions, but they must clearly disclose them at the time of sale.

What to do:

If you’re unsure whether a specific procedure will be covered as day care, you can formally request your insurer to confirm it in writing via email or through the customer portal. This is a standard industry practice and helps avoid any confusion or disputes during claims. Most insurers will respond with written confirmation when asked, especially if you mention it’s for clarity before proceeding with treatment.

While IRDAI doesn’t explicitly mandate written confirmations, its rules encourage clear, fair, and transparent communication. If your insurer refuses to provide clarity, you can escalate through their grievance cell or use the IRDAI grievance portal (IGMS).

3. Network Hospital Coverage for day care treatment in health insurance

Even if your plan allows cashless hospitalisation, not all hospitals in the network may offer cashless for day care specifically.

What to do:

Before undergoing a procedure, check if the hospital is part of the insurer's active day care network. Most insurers, including HDFC ERGO, Baja Allianz, Aditya Birla, and more, require pre-authorization for cashless claims.

4. Pre-Authorization Rules

IRDAI’s protection guidelines require that insurers clearly inform policyholders of pre-auth and claim processes at the time of purchase. Even so, insurers often require advance notice, even for daycare, if you want to go cashless. Miss this step, and you may be forced to pay upfront and claim later.

What to do:

Check how much prior notice is needed — is it 24 hours or 48 hours?

Also check: what's the process in emergency day care scenarios (e.g., an urgent minor surgery)? Will reimbursement work? How fast?

5. Reimbursement vs. Cashless Options

Sometimes, especially with smaller daycare centers or private clinics, cashless payment may not be available even if the treatment is covered.

What to do:

Understand what documents are needed for a successful reimbursement claim (discharge summary, surgeon's report, itemised bills, etc.) if the insurer has an app or online portal for this, even better.

6. Co-payment and Sub-limits on Day Care

Some policies add a co-payment or cap the claim amount for specific day care procedures, especially if the policy is for senior citizens or has a low premium.

An example is the Star Health Senior Citizens Red Carpet policy, which covers day care treatments with a 15% co-payment.

As per IRDAI norms, such sub-limits must be clearly stated in the policy brochure and terms & conditions;  insurers cannot apply them silently.

What to do:

Read the fine print. If the clause says something like "₹25,000 limit per cataract surgery", ask if it applies to all  daycare treatments in health insurance or just a few. These little details can make a big difference.

7. Understand the Fine Line Between Day Care and OPD

Not all short-duration treatments qualify as day care treatment in health insurance. Simple consultations, stitches, or physiotherapy may fall under OPD, and won't be covered unless your plan includes OPD benefits explicitly.

What to do:

If you expect to frequently visit doctors or require short treatments, ask if the plan includes OPD cover as well, or else you may be paying out of pocket.

Best Health Insurance Plans with Daycare Treatment 

These are some of the best plans you can buy that cover daycare treatments:

1. HDFC Ergo Optima Secure

• Covers day care treatments up to the full sum insured with no sub-limits or copayments.
• You also get home healthcare, AYUSH, free annual health checkups and domiciliary cover up to SI.
• Great for families — supports large family floaters (up to 10 members).
• Bonus: “Secure Benefit” doubles your base coverage from day one.
• Restoration is once per year; unlimited available via add-on.

2. Aditya Birla Activ One Max

• Covers day care procedures up to sum insured with no room rent limits or disease caps.
• Built-in consumables cover and free annual checkups included.
• Restoration activates after the first claim and works for the same illness too.
• Ideal for those with chronic conditions — optional add-on allows day-one coverage for select PEDs.
• Offers wellness rewards (HealthReturns) that can get you up to 100% of your premium back.

3. Care Supreme

• Covers all day care procedures up to SI with no disease-wise limits or room caps.
• Offers unlimited restoration, and cumulative bonus of up to 100% of base SI.
• AYUSH, domiciliary care, and e-consultations also included.
• Great flexibility via useful add-ons like consumables cover and OPD consultations.
• Wellness benefits and step-based rewards are a nice bonus.

4. Niva Bupa Aspire Titanium+

• Covers day care treatments up to the full SI from day one.
• Includes maternity & New born cover along with annual health check-ups and coverage for AYUSH and domiciliary treatments.
• Standout features like Booster+ (carry forward unused SI) and Lock the Clock (premium lock) enhance long-term value.
• ReAssure+ allows unlimited restoration — even for the same condition.
• Best suited for younger buyers who want strong digital benefits and global add-ons.

5. ICICI Lombard Elevate

• Covers day care procedures up to the full sum insured.
• Offers flexible add-ons like room rent upgrade, maternity, and consumables cover.
• Unlimited restoration and wellness discounts available.
• Great if you want a plan you can customise, but note: base variant is lean — most features are add-ons.
• Keep an eye on their claim settlement experience, which lags behind peers.

So, there you have the best health insurance plans with daycare coverage. Before we wrap up, here’s a quick clarification. A lot of people confuse OPD with day care treatment in health insurance. Here’s the difference.

Are OPD (Outpatient Department) Services the Same as Day Care Treatments?

Not quite. While both may involve short treatments, the key difference lies in hospitalisation and the nature of care.

Feature	OPD (Outpatient Department)	Day Care Treatment
Hospital Stay	Not required	Required, but less than 24 hours
Anesthesia/Surgery	Usually not involved	Often involves anesthesia or a surgical setup
Examples	Doctor consultation, minor tests	Cataract surgery, dialysis, chemo, lithotripsy
Insurance Coverage	Only covered if OPD is specifically included in the policy	Covered under most health insurance plans as standard benefit

Even though both are short-duration, only day care treatments are considered hospitalisation under most health policies. OPD services need explicit OPD cover to qualify for claims.

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Key Takeaways

• Day care procedures are short hospital-based treatments (done in <24 hours) that involve anesthesia or surgical infrastructure.
• IRDAI mandates that any procedure meeting this definition must be covered — even if it's not listed.
• Claims can be cashless (via pre-auth at network hospitals) or reimbursed (if unplanned or out-of-network).
• Common treatments include cataract surgery, dialysis, chemo, hernia repairs, and more.
• OPD services like consultations or diagnostics are not considered day care unless specifically covered.

Still unsure if your health insurance covers the proper daycare procedures?

Please don't leave it to guesswork. At Ditto, we help you understand what your policy covers — no jargon, no pressure. And if you're buying a new plan, we'll handpick one that fits your needs and budget. 

Talk to an advisor — it’s free, honest, and zero spam. Book your free call now.

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