Day Care Procedures List, Benefits and Exclusions

• With advancements in technology, numerous surgeries (both complex and simple) can now be effectively performed in a single day, allowing patients to be discharged from the hospital within 24 hours. Such medical procedures, which do not necessitate an overnight hospital stay, are classified as day care procedures.

What is a Day Care Procedure?

• A day care procedure denotes medical treatments or surgeries that, thanks to technological progress, require less than 24 hours of hospitalization. Historically necessitating longer durations of stay, these procedures now enable patients to be admitted, treated, and discharged all within the same day. Instances include cataract surgery, chemotherapy, dialysis, and radiotherapy. At Bajaj Allianz, our health insurance policies thoroughly cover various day care procedures, ensuring that you are provided with prompt medical attention without the need for extended hospital stays. This coverage not only delivers financial backing but also affords peace of mind, enabling you to concentrate 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 necessitate an overnight hospital stay.
• Treatments and consultations performed at the doctor’s office or outpatient clinic.
• Duration
• Treatment is finalized in one day, with the patient being discharged on the same day.
• Treatments typically consist of brief visits, usually not necessitating hospital admission.
• Hospitalisation
• No hospitalization is needed, although it may involve minor surgeries or treatments in a hospital environment.
• No hospitalization involved as it is generally managed in outpatient clinics or doctors’ offices.
• Coverage
• Included by most health insurance plans for surgeries or procedures that can be conducted in a day.
• Generally not included by many health insurance plans, although a few policies may offer OPD cover as an extra advantage.
• Cost
• Insurance frequently covers day-care treatments entirely, subject to specific terms and conditions.
• OPD visits often involve out-of-pocket expenses unless expressly included 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 encompass a broad spectrum of day care treatments, which are medical procedures that require hospitalization but do not necessitate a 24-hour stay. Due to medical advancements, treatments that previously required longer hospitalizations can now be completed within hours. These include surgeries, diagnostic procedures, and specialized therapies. Unlike outpatient treatments, day care procedures are included under the majority of health insurance plans, guaranteeing financial security for policyholders. However, coverage may differ among insurers, so it is crucial to examine the specific inclusions prior to acquiring 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 provide our customers with top-notch services, we at Bajaj Allianz deliver coverage for the majority of day care procedures within our various health insurance plans. There is a common misconception that day care procedures are excluded from health insurance, with many assuming that only extended hospital stays are covered. However, due to advancements in medical treatments, the time taken for procedures has markedly decreased, leading health insurance policies to adapt by covering these short-term hospitalization services.

• Although day care treatments are generally included, it’s crucial to emphasize that outpatient procedures (OPD), like routine consultations or minor dressings, are usually not part of the coverage. Thus, always examine your health insurance policy to comprehend the complete range of what is included and ensure that it satisfies your healthcare requirements.

Factors to be Considered When Choosing a Day Care Plan

• When picking a day care health insurance plan, it is important to reflect on several critical factors to guarantee extensive coverage and financial security.

1. Co-payment Clause: This clause indicates the percentage of the claim amount that the policyholder is required to pay out-of-pocket. Choosing a plan with a lesser co-payment percentage can lessen your financial strain during claims.

2. Sub-limits: Certain policies set sub-limits on particular treatments or procedures, limiting the payable amount. It’s wise to opt for a plan with few or no sub-limits to guarantee sufficient coverage for various treatments.

3. Age Limit: Health insurance policies frequently have age limitations for coverage. Ensure the plan accommodates your age group and provides coverage for day care procedures pertinent to your age.

4. Cashless Facility: A cashless facility permits you to obtain treatment without upfront payment, as the insurer clears the bill directly with the hospital. Verify that your selected plan includes this facility at a broad network of hospitals.

5. Network Hospitals: Confirm that the insurance provider boasts a strong network of hospitals, particularly those close to your area, to ease access to cashless treatments.

6. Pre- and Post-Hospitalisation Coverage: Investigate whether the policy includes medical expenses incurred prior to and after hospitalization, as these can accumulate significantly.

7. Waiting Period: Be cognizant of the waiting period for certain treatments or pre-existing conditions. Opt for plans with shorter waiting periods to guarantee prompt coverage.

8. Claim Settlement Ratio: Look into the insurer’s claim settlement ratio to evaluate their dependability in processing and resolving claims efficiently.

9. Premium Amount: While lower premiums can be appealing, ensure they correlate with the coverage and benefits provided. Balance cost-effectiveness with comprehensive coverage.

10. Exclusions: Meticulously review the policy exclusions to grasp what is not covered, avoiding unexpected issues during claims.

By thoughtfully considering these factors, you can choose a day care health insurance plan that aligns with your healthcare needs and financial circumstances.Benefits of Inclusion of Day Care Procedures in Health Insurance Policies

Here are the benefits of including day care procedures in health insurance:

1. Peace of Mind

• Being admitted to a hospital, even for just one day, creates anxiety. The substantial cost of treatment can certainly add to this anxiety. However, knowing that your day care expenses will be covered by your insurance provider can alleviate this anxiety and provide you with the necessary peace of mind.

2. Cashless Service

• If you are aware in advance of a surgery (day care procedure) that you or a family member will undergo, you can check with your health insurance provider to take advantage of cashless health insurance claim settlement for the listed day care procedures in your policy.

3. Tax Saving Benefit

• In India, you benefit from tax exemption under section 80D of the Income Tax Act for premium payments made towards your health insurance policy. Therefore, a policy that covers you and your family for day care procedures can provide you with an additional tax-saving benefit.

4. Best Medical Care

• You can receive treatment for day care procedures in network hospitals, where you will get the best medical care along with the convenience of cashless service. Treatment in a network hospital ensures you and your family members receive quality care, even if hospitalization is only for a brief period.

5. Health CDC Benefit

• Health CDC (Click by Direct Claim) is an exclusive feature offered by Bajaj Allianz in our Insurance Wallet app, enabling you to quickly and conveniently raise and settle claims up to INR 20,000.

Exclusions of Day Care Procedures

• OPD (Out-Patient Department) treatments, such as dental clean-up, are not included under day care procedures, and your health insurance provider will not reimburse you for these. While most plans cover day care procedures, OPD is usually not covered, making it essential to review the exclusions in health insurance policies to prevent filing claims for non-covered treatments.

• We suggest that you carefully read the policy wording and comprehend which day care procedures are included in your health insurance policy. Please discuss with your insurer about the inclusions and exclusions concerning day care procedures to avoid any issues when submitting a claim.

Conclusion

• Day care procedures, which enable patients to receive treatment and return home within 24 hours, are increasingly featured in health insurance policies. The inclusion of such procedures offers various advantages, such as peace of mind, cashless services, tax benefits, and access to quality medical care. Nevertheless, it is crucial to be aware of exclusions, such as OPD treatments, and to thoroughly review your policy to ensure you have complete coverage for day care procedures. Always consult with your insurer to understand what is covered and avoid complications when filing claims.

FAQs

What are day-care procedures?

• Day-care procedures refer to medical treatments or surgeries that do not necessitate an overnight admission to the hospital. They are generally brief, minimally invasive, and enable the patient to go home on the same day.

Is endoscopy classified as a daycare procedure?

• Indeed, endoscopy is recognized as a day-care procedure. It is a non-invasive diagnostic method that typically does not necessitate an overnight stay in the hospital.

What constitutes day-care expenses?

• Day-care expenses are the costs associated with medical treatments or procedures that are completed within a single day, encompassing consultations, diagnostics, and minor surgeries. These expenses are usually covered by various health insurance policies.

* Standard Apply

Insurance is the matter of solicitation. For more information regarding benefits, exclusions, limitations, terms, and conditions, please review the sales brochure/policy wording thoroughly before finalizing a sale.