What Is Day Care Treatment? Meaning, Examples & How It Works in Health Insurance

What Is Day Care Treatment in Health Insurance?

The idea of day care treatment is simple; it covers medical procedures that require hospitalisation for less than 24 hours. Advances in medical technology now allow treatments like cataract surgery, dialysis, biopsies, and some cancer therapies to be completed without overnight stays.

Earlier insurance policies mandated a minimum 24-hour hospital stay, leaving many such procedures uncovered and forcing patients to pay out of pocket. Today, regulators and insurers recognise day care treatments as an essential part of health insurance, aligning coverage with modern medical practice.

Common Day Care Procedures Covered Under Health Insurance

A significant part of claims today is for daycare procedures. In fact, one analysis found that roughly 29% of all health insurance claims are for day care procedures, a reminder of how prevalent these procedures have become.¹

While the exact list can vary from policy to policy, common medical procedures that typically fall under day care hospitalisation include:

1. Cataract surgery
2. Dialysis sessions
3. Cancer therapies like radiotherapy and chemotherapy
4. Angiography and other cardiac diagnostics
5. Minor orthopaedic or ENT procedures

These are just examples, and the defining feature isn’t the illness, but the fact that the treatment is completed on the same day. There is no need for an overnight stay.

Health Insurance Plans That Cover Day Care Treatments

In India, most modern retail health insurance plans include day care coverage as part of their standard benefits. While insurance policy coverages may differ, insurers have largely shifted to recognise daycare treatments.

For instance, individual health plans, group policies, or senior citizen health covers tend to include day care benefits. This means the insurer will pay for procedures that meet the day care definition up to the sum insured. At Jio Insurance Broking, you can compare different insurance policies to choose the one that provides the best day care treatment coverage.

How Does Day Care Treatment Coverage Work in Health Insurance?

Here’s a simple breakdown of how day care treatments work:

Admission & Treatment

You go to a hospital or a registered day care centre for a procedure. If the treatment can be completed in a few hours and discharged the same day, it counts as day care.

Cashless vs Reimbursement

• Cashless: If the hospital is in your insurer’s network, you may get treatment without paying upfront (subject to pre-authorisation).
• Reimbursement: If you seek medical care from a non-network hospital, you can submit bills later for reimbursement.

Claims Process

You submit the required medical documents and receipts after treatment. The insurer assesses and pays within policy terms. This applies whether it’s day care or traditional hospitalisation.

No Minimum Hospital Stay

Under the modern approach, there’s no longer a rigid 24-hour stay requirement for eligible day care procedures, a big change from past practice.

Benefits of Day Care Treatment Coverage

Including day care treatment in your health insurance plan offers several clear benefits. Some of the striking ones are:

Reduced Out-of-Pocket Costs

Even short procedures can be expensive, especially cancer therapies, dialysis or complex diagnostics. Day care coverage helps absorb these costs.

Reflects Modern Healthcare

Insurance no longer penalises patients for brief hospital stays that medical advancements have made possible.

Better Coverages

Day care coverage means better coverage under health insurance. You need not panic even if it's a day visit to the doctor. Such expenses are also covered, lowering the burden of overall medical expenses.

How to Choose the Right Day Care Health Insurance Plan?

When evaluating plans, make sure to consider the following elements:

What's Covered

Some policies clearly mention the conditions covered under day care treatments, while some may simply mention treatments done without 24-hour hospitalisation. Knowing which approach your policy uses matters.

Cashless Network

A broader hospital network gives you more options for cashless treatment. At a cashless hospital, you can seek admissible treatments without having to pay from our pocket. The insurer directly settles bills with the hospital.

Sum Insured

A higher sum insured means better financial protection for repeated procedures like dialysis or chemo sessions. It is crucial to understand the limits of medical coverage.

Claim Settlement Reputation

To understand the claim settlement ratio, look at regulator reports and consumer feedback on how fairly insurers settle claims. It gives you clarity and helps choosing the right insurer.

How to File a Day Care Treatment Claim in Health Insurance?

The claim-filing process for day care treatments is similar to any other claim:

1. Inform your insurer or third-party administrator before planned procedures
2. For pre-planned cashless claims, obtain pre-authorisation from your insurer
3. After treatment, submit all medical and billing documents promptly
4. Follow up with the insurer until the claim is settled.

In practice, the time required to complete the claim settlement procedure may differ from one insurer to another.

OPD, Dental, and Maternity Coverage in Health Insurance

OPD or outpatient department coverage applies to doctor consultations, diagnostics, and treatments without hospitalisation. This benefit is usually optional and separate from day care coverage.

Dental coverage for basic treatments may also be separate. Cosmetic or elective dental procedures are typically excluded unless medically essential.

Maternity coverage generally comes as an add-on with waiting periods (9-24+ months) and is not inherently included in regular day care benefits. It focuses on prenatal, delivery, and newborn care costs.

Conclusion

Today, with treatments being quicker and less invasive, day care treatment coverage is no longer optional; it is essential. Day care coverage in health insurance is truly a fantastic feature offered by health insurance companies. Whether it's cataract surgery or cancer therapies, day care treatment coverage significantly reduces your out-of-pocket expenses.

When you are choosing the right health insurance policy for yourself and/or your loved ones, make sure to check out the daycare cover, including its inclusions and exclusions. At Jio Insurance Broking, we bring you some of the best possible options, that too at an affordable premium. A well-chosen plan can offer not just financial relief, but also peace of mind when the right treatment matters most.

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