What is Day Care Treatment in Health Insurance?

Day care procedures refer to those medical treatments or procedures that are done at the hospital or healthcare centre but do not require hospitalisation for more than 24 hours. Traditionally, these procedures would require an extended hospital stay; however, with the use of advanced technology, they can now be carried out more quickly.

Most health insurance online plans cover day care procedures under their blanket, relieving the insured from the burden of expenses. Thus, if your day care procedure falls under the day care procedures list mentioned in your insurance policy, the expenses of the treatment will be covered up to the sum insured or as per the policy terms.

Covers the Cost of Day Care Procedures

Day care procedures are short but involve considerable cost, as most of them are carried out using advanced technologies. For example, cataract surgery is a complex procedure involving replacement of the eye lens. However, using advanced technologies, this surgery is performed quickly and the patient is discharged within a few hours.

A lot of times, the cost of such surgeries is on the higher side. Thus, the inclusion of day care treatments in health insurance helps to cover the cost of such procedures, reducing the financial burden on the insured.

Accessibility to Modern Medical Treatments

Coverage of day care treatments in health insurance online makes modern treatments more accessible to a large number of people. The inclusiveness of day care procedures in health insurance ensures that your policy is aligned with your advanced healthcare needs.

The inclusivity of several day care procedures under insurance enables individuals to seek timely and top-quality healthcare procedures.

Useful for Elderly and Chronically Ill

Elderly people and those with chronic illnesses often require day care treatments to manage their health. The inclusion of these procedures in health policies allows them to receive the treatment on time and keep the disease under control. For example, someone who requires frequent dialysis can receive it under a day care procedure without draining the savings.

Insurance Utilisation

Health insurance with coverage for day care procedures enables efficient utilisation of the insurance plan, even if you do not face major hospitalisation requirements during the policy year. You can utilise the insurance even for small yet important procedures.

Note: The exact day care coverage may vary according to the policy terms. To find out the exact coverage, please refer to the policy documents.

Here is a list of procedures covered under TATA AIG’s health insurance plans.

Note: This list is not exhaustive. To get the entire list of procedures covered, you may refer to the policy document or contact the customer assistance at TATA AIG.

Also Read: Family Health Insurance

Both OPD and day care treatment may appear similar due to the shorter hospitalisation time. However, both of these treatments are different from each other and have different coverage in health insurance.

Those with Chronic Illnesses

Individuals suffering from chronic illnesses such as kidney ailments, arthritis, diabetes, etc., may have to undergo day care procedures, such as injections, infusions, dialysis, etc., on a regular basis. They can take advantage of the day care benefits in insurance and get coverage for the regular expenses incurred on the treatment.

Elderly Individuals

Elderly individuals who are at an advanced age may develop age-related conditions, such as cataracts, heart disease, etc. Such conditions can be treated with day care procedures, such as cataract surgeries and angiography, without requiring hospitalisation, benefiting the elderly.

Individuals with Critical Illnesses

Day care benefits also extend to individuals suffering from critical illnesses. Chemotherapy, radiotherapy and many other critical illness treatments are covered under day care procedures, bringing relief to the insured.

People Requiring Minor Surgeries

Health emergencies may sometimes require minor surgeries, such as suturing, hernia repair, cyst excision and many others. All these treatments form part of the day care procedure coverage, saving the insured from having to spend from their own pockets.

Also Read: Benefits of Comprehensive Health Insurance Plans in India

When buying health policy, it is crucial to pay attention to the number of day care procedures included. However, there are several other factors that you should consider.

Day Care Procedures Covered

When looking at the day care procedures covered under insurance, it is not just sufficient to look at the day care procedure list. Rather, one must also consider the expansiveness of the procedures. For instance, consider the category of treatments covered, such as urology, gynaecology, dental, ENT, gastroenterology and so on.

Co-Payment and Sub-Limits

Co-payment clauses and sub-limits in insurance increase your out-of-pocket expenses and reduce the claim amount. Thus, it is essential to review the conditions related to both of these in your day care procedure coverage.

Sum Insured

Opt for health insurance with a sufficient sum insured amount so that the cost of day care procedures is adequately covered. Some day care treatments can be expensive, such as chemotherapy, dialysis, etc.. Hence, a higher sum insured would always be a wise choice.

Inclusions And Exclusions

Find out the procedures that are included in the day care coverage of your insurance plan to know what you are going to get out of the plan. At the same time, you should also find out the exclusions to understand what is not covered, as you will bear the cost of the exclusions.

Pre-Existing Conditions

If you have any pre-existing conditions such as thyroid, diabetes and so on, there may be a waiting period attached to them. During the waiting period, you will not be eligible to receive any coverage for the day care procedures related to the pre-existing conditions.

Also Read: Pre-Existing Diseases Cover in Health Insurance

Since day care procedures are a part of the base health policy, the procedure for filing the claim is similar to a regular insurance claim. You can also choose between reimbursement and a cashless claim. Here are some steps to follow.

Under Cashless Claim

• Inform us in advance (at least 48 hours prior) if your day care procedure is a planned one and get the pre-authorisation.

• Submit all the required documents related to the treatment, such as medical reports, evaluation results, doctor’s prescriptions, etc.

• Once the verification is complete, TATA AIG will send you the pre-authorisation letter.

• Submit the pre-authorisation letter and other documents to the hospital and get the treatment done.

• TATA AIG will directly pay the cost of the treatment to the hospital as per the policy’s terms.

Under Reimbursement Claim

• Go to any hospital of your choice and get the day care procedure done.

• Preserve all the medical reports, doctor’s prescriptions, treatment bills, etc.

• Next, submit a claim application along with all the relevant documents and bills to support your claim.

• We will verify the details and upon successful completion, the day care procedure cost will be reimbursed to you as per the policy terms.

The inclusivity of day care procedures in health insurance brings significant relief, saving you from incurring out-of-pocket expenses for medical treatments. TATA AIG offers day care procedure coverage in many of its insurance plans, ensuring comprehensive medical coverage for you and your family.

With TATA AIG’s best health insurance policy, you get comprehensive coverage for day treatments related to gynaecology, dental, radiology, general surgery and much more. Besides, you get access to cashless claims, discounts, lifelong renewability, quick claim settlement and many such benefits.

Get health insurance from TATA AIG to get adequate assistance during medical emergencies for yourself and your loved ones.