Day Care Procedures Covered under Health Insurance

Are you planning to buy a health insurance policy for yourself? It is certainly one of the wisest decisions that you can take, considering the various advantages offered by a health insurance.

But wait! Before you buy the policy, you need to evaluate the various types of diseases that are covered under it. In addition to that, do not forget to check the list of daycare procedures that are covered by the policy.

Introduction to Day Care Treatments

Are you wondering what Daycare procedures are? These are the treatments that can be completed within one day, or more specifically in less than 24 hours. These procedures can be done under local or general anesthesia in an outpatient clinic or hospital, and there is no need for the patient to remain admitted in the hospital overnight.

Examples of day care treatments include cataract removal, surgery for Retinal detachment, skin transplantation, etc.

Need for Your Health insurance to Cover Day Care Treatments

With the rapid advancements made by medical science in the recent years, a number of treatments and surgical procedures which earlier used to require overnight hospitalization can now be completed in less than 24 hours. Treatment of many diseases has become extremely simple and hassle-free, thanks to the availability of advanced surgical procedures and state-of-the-art equipment to support the physicians. Such treatments now fall under the category of day care procedures.

The commonest example of this is a cataract removal surgery. Even a few years back, the patient had to be hospitalized overnight to get a cataract removed, and the treatment used to take several days. However, now it takes only a few hours and unless there is any medical complication, the patient does not have to stay overnight. So, cataract operations used to fall under the category of overnight treatments earlier, but now they come within the day care surgery list.

Thus, it is important that the health insurance policy you buy should cover as many day care treatments as possible. This is extremely important if you want the policy to truly protect you.

Day Care Treatments that are Covered

The policy document of the insurance plan that you will purchase will contain the detailed list of all the day care procedures that will be covered by it. The concept is simple to understand: if the day care surgery list of the policy document does not cover a certain illness, then it is most likely that the expenses you may incur on its treatment for it will not be covered by the health insurance policy. Hence it is important to read the policy document very carefully.  These documents do not leave anything unsaid, so do not assume that a particular day-care procedure will be covered unless it is written in the policy wordings expressly.

Another thing to remember is that a treatment in an outpatient department is not the same as a day care procedure. While day care procedures require the patient to remain hospitalized, even if it is for a few hours, OPD treatment generally do not. If the patient is going for an OPD treatment, he/she can simply walk away after the treatment is over. There is no hospitalization required in such a case, and therefore these treatments are not covered by health insurance.

The difference between an OPD treatment and a day care treatment is often very thin, making it very confusing to distinguish between the two. For example, if the patient goes for removal of dental tartar, then the procedure can be completed in less than an hour and is an OPD procedure. However, a dental surgery done to rectify a deformity in the teeth requiring hospitalization for a few hours will be treated as a day care procedure. While both of these can be regarded as treatments for beautifying the teeth, a claim can be made for the latter procedure, while the expenses for the tartar removal cannot be claimed.

Some of the day care procedures that are covered by health insurance and fall within the day care surgery list are as follows:

  • Operations on the eyes
  • Incision of tear glands
  • Incision of diseased eyelids
  • Incision of the cornea
  • Other operations on the cornea
  • Removal of a foreign body from the lens of the eye
  • Removal of foreign particles from the orbit and eyeball
  • Operation of cataract
  • Nose
  • Excision and destruction of diseased tissue of the nose
  • Nasal sinus aspiration
  • Foreign body removal from nose
  • Other operations on the nose
  • Bones and joints
  • Surgery for ligament tear
  • Surgery for meniscus tear
  • Removal of fracture pins/ nails
  • Trauma surgery
  • Incision on bone, septic and aseptic
  • Mouth
  • Removal or operations of tonsils
  • Operations on salivary glands & ducts
  • Dermatological (skin) procedures
  • Skin transplantation
  • Chemo-surgery to the skin

These are just some of the daycare procedures. As we said earlier, with the rapid progress being made by medical science, the list is becoming longer every day. Therefore, while buying insurance policy, check the list of daycare procedures included, and always go for the one that gives you the most comprehensive cover.

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

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