Over the years, there has been a significant advancement in the healthcare industry. Treatments and procedures that once required days of hospitalisation can now be performed in hours. These advancements allow patients to be admitted by breakfast and discharged by dinner!
But historically, health insurers have mandated a minimum of 24 hours of hospitalisation to cover the treatment. Nowadays, recognising these changes, most top-notch health insurers have removed this barrier and cover day-care treatments.
Day-care treatments include a variety of treatments and surgeries such as dialysis, chemotherapy, appendicitis, cataracts, etc.
Nevertheless, it’s important to note that some treatments might have certain disease-wise sub-limits and restrictions. For example, in the case of cataract treatment, the lens cost may not be covered. And some other treatments may not be covered at all. Let’s explore this in detail now!
What is Daycare Treatment in Health Insurance?
Daycare Treatment in health insurance refers to treatments/surgeries/procedures that can be covered under 24 hours of hospitalisation. According to the IRDAI (Insurance Regulatory and Development Authority of India), to be classified as a daycare procedure, a treatment needs to fulfil the following conditions -
- It has to be undertaken under General or Local Anesthesia in a hospital/daycare centre or
- The procedure has to be conducted in less than 24 hrs because of technological advancement (which would otherwise have taken more than 24 hours).
Let’s understand this better with an example:
Your grandfather has been squinting while reading the newspaper for some time despite his accurate spectacles.
You take him to the doctor, who discovers he has cataracts. He also adds that you needn't worry since the procedure will only take a few hours and require very little post-follow-up check.
Your grandfather walks into the hospital at 10 am and leaves at 1 pm. The 2nd best thing? - Your insurer covers it as a daycare treatment!
(P.S. Considering that you have one of the best health insurance plans in the market with no restrictions/clauses on your daycare treatment coverage.)
Apart from cataracts, a whole host of other treatments are usually considered day-care treatment, which are as follows:
What are the different Daycare Treatments in Health Insurance?
- Cataract: As you age, your eyes may gradually cloud, which can be removed by surgical operation. This is called cataract surgery and is one of the most common daycare procedures in India.
- Angioplasty: Angioplasty is a procedure that widens a blocked artery by inserting a narrow tube with a balloon at the end, which is inflated to widen the artery. This ensures that the calcium build-up does not affect the blood flow.
- Appendicitis: The appendix is a small organ emerging from the large intestine. A block in the appendix could lead to swelling and rupture, which is fatal. This is called appendicitis. Surgery for appendicitis is often a procedure that can be completed within 24 hours, and it is one of the most common day-care procedures.
- Tonsillectomy: When tonsils are enlarged, it becomes difficult to breathe and swallow. This is called tonsillitis, and the surgical removal of tonsils is called a tonsillectomy.
- Myringotomy: A myringotomy is a procedure in which the doctor creates a small incision and inserts a tube into the eardrum to drain fluid. This relieves pressure from the ear and is often performed to treat ear infections behind the eardrum.
- Colonoscopy: Sometimes, our intestines must be checked for abnormalities like polyps, inflammation, or cancer. Once again, this is done through a tube but with a camera on the other end. The doctor examines for the said abnormalities and takes a tissue sample if required.
- Chemotherapy: There are two main types of cancer treatments. One involves powerful drugs that the patient consumes to control the growth of cancerous cells. This is called chemotherapy.
- Radiotherapy: The other main treatment for cancer is radiotherapy. This uses targeted radiation beams to destroy cancer cells in the body. It is usually painless and involves continuous treatment for several days.
- Dialysis: Your kidney is the organ that purifies blood and other waste products from your body. Sometimes, people may experience kidney failure, which prevents them from performing their normal functions. For such cases, your blood is pumped into an external machine that filters out the impurities and pumps it back into your body. This is called dialysis.
These are a few of the common procedures and treatments that are considered daycare treatments. However, as always, you must keep in mind that it varies from policy to policy, and you must always check the documentation for the exact features, terms, and conditions of your policy.
What are the best health insurance plans offering Daycare Treatment?
These are some of the best plans you can buy that covers daycare treatments:
- HDFC Optima Secure—This is one of HDFC ERGO's policies, designed to provide comprehensive coverage for most treatments, including daycare procedures. It doesn’t have any extra bells and whistles like maternity and OPD, but it has almost everything that most people need; additionally, HDFC ERGO is a top health insurer pick in the industry.
- Care Supreme – This is one of the top offerings of Care, which also covers daycare procedures. The only drawback with this plan is that it has a pre-existing disease waiting period of 4 years, but you can reduce that with an add-on. Unlike Optima Secure, this also covers OPD with add-ons.
- TATA AIG Medicare Premier — This is one of the company's flagship offerings. Medicare Premier has no copayment, room rent restrictions, or disease-wise sub-limits. It also has the Tata brand name, which many people believe in. This policy offers maternity and OPD coverage. But unlike the other plans in this list, this policy also offers dental OPD and international coverage.
- Aditya Birla Activ One — This policy covers 7 pre-existing diseases (PEDs) from day 1. People with chronic conditions such as diabetes, hypertension, hyperlipidemia, etc., would find this policy useful. To make this policy more accessible to a wide demographic, Aditya Birla is offering several variants with slightly different features. For instance, annual health check-up is built into some variants but is an add-on in Activ One NXT. Consumable cover is an add-on in some variants but is built into others. Overall, this is a good policy that has no room rent limits, co-payment, or disease-wise sub-limits.
- Bajaj Allianz Health Care Supreme Ultimo — This policy has better maternity and OPD coverage than other Bajaj plans. However, the number of network hospitals is slightly lower than most policies, and the no-claim bonus is also not that attractive. So, if maternity and OPD are your main priorities, this policy would be better suited for you.
What is the difference between Daycare Treatment and OPD Coverage in Health Insurance?
| Basis | OPD | Daycare |
|---|---|---|
| Definition | Out-patient department (OPD) refers to medical treatment or consultation that does not require admission to a hospital. This could include visits to a doctor's clinic or medical centre, diagnostic tests, and medical procedures. | Any treatment that would take less than 24 hrs, undertaken under general or local anaesthesia, primarily due to advancements in medical technology, can be categorised as a daycare treatment. |
| Example | A consultation with your ophthalmologist | A cataract surgery |
| Ailments Covered | Doctor appointments for regular ailments such as a cold or fever | Hospitalisation for minor surgeries, chemotherapy, dialysis, etc. |
| Pros |
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| Cons |
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| Best Plans Offering This | Care Supreme (Add-on), Care Plus, Aditya Birla Activ One VYTL | HDFC ERGO Optima Secure, Care Supreme, Niva Bupa ReAssure 2.0, Aditya Birla Activ One |
Things to check about Daycare Coverage when opting for a health insurance plan
- Disease-wise sub-limits: Some policies may have a limit for day-care procedures. Ensure that your policy has no such limits for maximum coverage.
- Ensure that your insurer covers the procedure: Some policies have a list of treatments and procedures for daycare treatment, whereas some policies rely on the definition. Before availing of the treatment, you must check whether your insurer even covers it.
- Network hospitals: Ensure that your policy has a good number of network hospitals that are close to where you live.
Conclusion
Daycare coverage is an important part of health insurance. With a positive outlook on the medical-tech industry, more treatments could be performed within 24 hours in the future. Some common treatments, such as cataracts and appendectomies, are considered daycare treatments, and having these covered by your insurance can only give you more peace of mind.
You must also check whether your policy covers the specific ailment and whether it has a disease-wise sub-limit for that ailment.
Ultimately, numerous plans offer good coverage for daycare treatments, and we can make informed decisions by understanding and comparing the policy details to find the best option for our needs.
