Introduction

Health insurance plan normally cover 24 hours inpatient hospitalization for medical treatment. As modern medical treatment have become advance and technological innovative, most of treatment does not require 24 hours hospitalization. This kind of treatment is called daycare treatment.

Let us understand Daycare treatment benefits, features and requirement in health insurance from this article.

What is Daycare Treatment in Health Insurance?

Daycare treatment refers to medical procedures or surgeries that require hospitalization for less than 24 hours due to advanced medical technology and infrastructure. Earlier, health insurance in India only covered treatments involving a minimum of 24 hours of hospitalization. But with medical advancements, many treatments today can be completed in a few hours, prompting insurers to extend coverage to such procedures under daycare treatments.

Why Daycare Procedures Are Covered Separately

Health insurance policies have evolved to align with modern healthcare needs. Earlier, if a procedure didn’t meet the 24-hour hospitalization requirement, the insurance wouldn’t cover it—even if it involved surgery or costly treatment. This led to considerable out-of-pocket expenses for patients. To bridge this gap, IRDAI mandated insurers to include a list of daycare treatments in their policies, ensuring broader and more relevant coverage.

How Many Daycare Procedures Are Covered in Insurance?

The number of daycare treatments covered can vary widely across insurers and plans. Most comprehensive health insurance policies in India cover between 140 to 600+ daycare procedures, depending on the plan’s sum insured and benefits. These procedures are usually listed in the policy document or annexure.

Some insurers even offer custom daycare benefits for critical illness plans or top-up covers, adding more flexibility for policyholders.

Popular Examples of Daycare Treatments

Here are some common medical procedures that fall under the category of daycare treatment:

• Cataract surgery
• Dialysis
• Chemotherapy and radiotherapy
• Colonoscopy
• Angiography
• Septoplasty
• Tonsillectomy
• Hernia repair
• Lithotripsy (kidney stone removal)
• Minor orthopedic surgeries

These treatments may only take a few hours but involve specialized equipment, anesthesia, and recovery protocols, making insurance coverage essential.

Things to Keep in Mind While Availing Daycare Cover

1. Check the List of Covered Treatments: Always read the list of covered daycare procedures in your policy wording. This list may differ from one insurer to another.
2. Cashless vs. Reimbursement: Ensure that the hospital is part of the insurer’s network for a smoother cashless process. Otherwise, you’ll need to file for reimbursement.
3. Not All OPD Treatments Are Covered: OPD (Outpatient Department) consultations and diagnostic visits are different from daycare treatments. A daycare procedure must involve hospitalization, even if for less than 24 hours.
4. Pre and Post-Hospitalization Costs: Some plans also cover pre- and post-hospitalization expenses (usually 30-60 days), even for daycare treatments. Verify this in your policy.

How to File a Claim for Daycare Treatment

The claim process for daycare procedures is generally similar to that of standard hospitalization claims:

For Cashless Treatment:

• Visit a network hospital.
• Show your health insurance card.
• Fill out the pre-authorization form.
• The hospital will coordinate with the insurer for approval.
• Once approved, undergo the procedure and get discharged.
• No need to pay upfront (except for non-covered items or deductibles).

For Reimbursement:

• Get treated at any hospital.
• Collect all medical reports, bills, and discharge summaries.
• Fill out the insurer’s reimbursement claim form.
• The insurer will process and credit the approved amount.
• Submit documents within the insurer’s stipulated timeline.

Benefits of Daycare treatment in Health Insurance

There are several benefits of Daycare health insurance offers,  a few mentioned below

• Short duration in hospitalization– Modern medical treatment does require 24 hours hospitalization.
• Less Financial burden– Daycare treatment covers minor medical procedure which can be expensive.

Maximum Coverage: Some health plans cover wide range of daycare procedures which is mentioned in policy

How to select Daycare Health Insurance?

In India most of health insurance companies will provide maximum numbers of daycare procedure in their policy. As policyholder one must look at cashless facility, sub limit, sum insured, age limit, co-pay, etc. as all factors plays important role in daycare procedure.

1. No of Daycare procedure: Policyholder must be aware of number of daycare procedure covered in his health insurance policy. As broad range procedure can be beneficial and have inclusive approach as many procedures are covered in health insurance.
2. Coverage:  Opt for higher sum insured for better coverage that matches costly treatment of daycare.
3. Check inclusion and exclusion: Make sure health plans covers common procedure inclusions and procedures which are excluded from the policy.
4. Co-pay:  Check for co-pay clause in daycare treatment in health insurance as to avoid out of pocket expenses.        

Conclusion

Daycare treatment coverage in health insurance is a crucial benefit that ensures you are not financially burdened by short-duration but expensive medical procedures. With the rise in same-day surgeries and non-invasive techniques, this feature makes modern healthcare more accessible and affordable.

Whether you’re buying a new policy or reviewing your existing one, make sure it includes a comprehensive daycare treatment list—and don’t forget to check the network hospitals for a hassle-free experience.