Day Care Treatment in Health Insurance: What Is Covered, What Is Not, and How Claims Work
Medical treatment has changed faster than insurance awareness. Procedures that once required days of hospital stay are now completed within hours, using advanced technology and specialised care. However, many policyholders still assume that shorter hospital stays mean no insurance coverage. Daycare treatment exists to bridge this gap.
In this blog, we explain the meaning of day care treatment in health insurance and provide the latest list of covered day care procedures.
What is Day Care Treatment in Health Insurance?
Daycare treatment in health insurance covers medical procedures that need hospital admission but are completed within 24 hours. Due to modern medical technology, many treatments no longer require long hospital stays, allowing same-day admission and discharge.
Even though these treatments do not meet the traditional 24 hour hospitalisation rule, they are still covered by insurance under daycare benefits.
Day care coverage is only one part of a complete health insurance plan. Explore the different types of health insurance to make the right choice!
Day Care Treatment List Covered Under Health Insurance
| Medical Category | Common Day Care Treatments Covered |
| Eye Treatments | Cataract surgery, glaucoma surgery, corneal procedures, and retinal treatments |
| Cancer Treatments | Chemotherapy, radiotherapy, and immunotherapy sessions |
| Digestive System | Endoscopy, colonoscopy, liver aspiration, and minor gastrointestinal procedures |
| Bones and Joints | Arthroscopy, minor fracture repair, tendon and ligament repair |
| ENT Procedures | Tonsillectomy, adenoidectomy, septoplasty, sinus surgery |
| Urinary System | Lithotripsy for kidney stones, cystoscopy, and minor urological procedures |
| General Procedures | Dialysis, blood transfusions, wound debridement, biopsies, and hydrocele surgery |
Note: The exact list of day care treatments can vary across insurers and policies. Always refer to your policy document to confirm coverage for a specific procedure.
How Daycare Treatment in Health Insurance Works
Daycare treatment in health insurance works by covering medical procedures that require hospital admission but are completed within 24 hours. Even though the patient does not stay overnight, the treatment is still treated as hospitalisation for insurance purposes.
For example, a person undergoes cataract surgery in the morning and is discharged the same day. Since cataract surgery is listed under daycare treatments, the health insurance policy covers the hospital expenses either through a cashless claim at a network hospital or through reimbursement if the hospital is not on the insurer’s network.
How to Choose a Health Insurance Plan with Day Care Coverage
You must choose a plan that covers a wide range of daycare procedures and clearly mentions daycare treatment in the policy wording.
- Check that common procedures are covered up to the full sum insured, without strict sub-limits or high co-payment clauses.
- Ensure the policy includes pre and post hospitalisation expenses.
- It should offer cashless treatment at nearby network hospitals and have reasonable waiting periods for common conditions.
- Also, remember that daycare treatment requires hospital admission and is different from OPD care, which usually needs a separate add-on.
Process of Daycare Claims in Health Insurance
The claim process mainly depends on whether the hospital is part of the insurer’s network or not.
Two Ways Your Daycare Claim Gets Settled
Health insurers settle daycare claims in two ways.
- One is the cashless route, where the insurer pays the hospital directly.
- The other is the reimbursement route, where the policyholder pays first and later claims the amount from the insurer.
Cashless Daycare Claims: When the Hospital and Insurer Settle Directly
If the daycare procedure is planned at a network hospital, the cashless option can be used.
- The policyholder needs to inform the insurer in advance, usually at least twenty-four hours before the procedure.
- At the hospital, the health card is presented at the insurance desk, and a pre-authorisation form is submitted.
- Once the insurer approves the request, the treatment is carried out, and eligible expenses are settled directly between the insurer and the hospital.
- The patient only pays for non-payable items, if any.
Reimbursement Daycare Claims: When You Pay First and Claim Later
When the treatment is done at a non-network hospital, the policyholder has to bear the expenses initially.
- After the procedure, all claim-related documents must be collected carefully.
- These documents are then submitted to the insurer within the time limit mentioned in the policy.
- After verification, the insurer reimburses the approved claim amount to the policyholder’s bank account.
A well-planned health insurance strategy often includes more than one layer of protection. Learn how top-up and super top-up health insurance plans can enhance your coverage when medical costs rise.
Documents You Should Keep Ready Before Filing a Daycare Claim
For a smooth claim process, the following documents are usually required.
- A duly filled claim form
- Doctor’s prescription or medical advice
- Diagnostic and investigation reports
- Original hospital bills and payment receipts, discharge summary, and a copy of the health card or policy details.
What Usually Delays or Rejects a Daycare Claim
Daycare claims are often delayed or rejected due to missing documents, incorrect information, late submission, or when the procedure is not listed under daycare benefits in the policy. Lack of pre-authorisation in cashless claims and policy exclusions can also affect claim approval. Reading the policy wording carefully and informing the insurer in advance helps avoid such issues.
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Day Care Treatment – FAQs
Daycare treatment in health insurance covers medical procedures that require hospital admission but are completed within 24 hours. These treatments are covered even without overnight hospitalisation.
Daycare treatment involves hospital admission for a medical procedure, while OPD care includes routine consultations or tests without hospital admission. OPD is usually not covered unless taken as an add-on.
Daycare treatment in insurance refers to modern medical procedures completed within 24 hours that still qualify for insurance coverage. These are covered under a specific daycare clause.
Daycare insurance is not a separate policy but a feature within health insurance that covers short-duration hospital treatments. It ensures coverage despite same day discharge.
A day care claim is a health insurance claim filed for a procedure completed within 24 hours of hospital admission. It can be settled through cashless or reimbursement mode.
The concept of daycare recognises that medical advancements allow faster treatments without long hospital stays. Insurance still covers these treatments as hospitalisation.
A day care claim is raised when an insured person undergoes a listed daycare procedure and seeks insurance coverage. The claim is processed under the daycare benefit of the policy.
