Day care procedures in Health Insurance

  • postauthorRaj
  • postdateMarch 6, 2023
  • postreadtime3 min read
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Health insurance has now become a necessity like food, clothing and shelter. Having a policy that offers you coverage for hospitalization expenses, thus saving out-of-pocket expenses is a boon. A health insurance policy covers all types of treatment and hospitalisation including short medical procedures that do not require you to stay in the hospital for long. Under health insurance, such procedures are known as daycare procedures. Read on to know all about daycare procedures and their coverage under health insurance. 

What are daycare procedures in health insurance? 

With the impact of technology, medical procedures that required an individual to get hospitalised can now be completed in less than 24 hours. Such medical treatments or surgeries that do not require hospitalisation for more than 24 hours can be termed daycare procedures. Today, most health insurance policies offer coverage for daycare procedures like chemotherapy, radiotherapy, dialysis, cataract, etc. An individual can file a claim for a daycare procedure only in case he is not hospitalised for more than 24 hours. 

It is important to note that daycare procedures should not be confused with OPD consultations and hospitalisation expenses. Day care treatments strictly refer to procedures that require less than 24 hours of hospitalisation, whereas, hospitalisation above 24 hours is treated as hospitalisation expenses.   

How do daycare procedures in health insurance help?

Importance of daycare procedures in health insurance 

  • Non-hospitalization costs almost amount to twice the cost of hospitalization 
  • No need to spend out of pocket as the insurance company offers coverage 
  • Illnesses like cancer and kidney failure require treatments like chemotherapy, dialysis which do not need you to get hospitalised for more than 24 hours 
  • Advancement in medical technology has made it easy for individuals to receive treatment in less than 24 hours 
  • A cashless claim can be availed in case the insured is hospitalized at a hospital that falls under the network of the insurance company 
  • Access quality daycare procedures at top hospitals covered by the insurer   

What is not covered under daycare procedures? 

Daycare procedures do not include medical consultation for minor injuries, seasonal illnesses, or regular consultations that are usually covered under OPD treatment. OPD treatments do not include any surgical procedures and hence, are not covered.  

Difference between daycare procedures and OPD treatments 

  Daycare procedures  OPD treatments 
Meaning  These are treatments that require hospitalization for less than 24 hours  These refer to day-to-day doctor treatments like minor stitches, fractures, etc 
Hospitalization  Hospitalisation for less than 24 hours  Does not require hospitalisation 
Examples  These include chemotherapy, ligament tear, dialysis, etc  Seasonal flu, regular health check ups, injury, consultations, etc 
What’s covered?  These are covered up to the sum insured including pre and post-hospitalisation expenses  Coverage is offered up to a specific amount which differs from insurer to insurer 


Factors to consider when buying daycare health insurance 

Having daycare procedures covered under health insurance can save you from the financial burden of medical expenses that do not require hospitalisation longer than 24 hours. However, it is best to consider the factors below. 

Total sum insured: Check if the sum insured chosen would be enough for the daycare treatment requirement you are looking to get 

Inclusions and exclusions: Check the list of daycare procedures covered and the treatments that are excluded  

Network list of hospitals: Check on the network list of hospitals and if all the hospitals in your vicinity are covered  

Choosing group health insurance cover daycare procedures for your employees 

The cost of healthcare is rising constantly and so are lifestyle diseases, hence, it is best to protect employees with a comprehensive employee healthcare plan that offers coverage for daycare procedures as well.   

You can choose to purchase an Onsurity healthcare membership for your employees to offer health insurance cover and a host of wellness benefits like teleconsultation, discounts on pharmacy, diagnostics, etc. With coverage for daycare procedures, Onsurity membership can be purchased by startups and SMEs on a monthly subscription basis, with plans starting at Rs. 145/month. 

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