Health Insurance September 19, 2020

What is a Day-Care Procedure in Health Insurance

Some medical treatments are performed within the time limit of 24 hours, but Health insurance companies generally cover the medical charges only when there is at least one day of hospitalization. However, to make an exception, Daycare procedures are included in the policy coverage by some insurers. As a result, health insurance companies are paying the costs incurred on such treatments. The Insurance Regulatory and Development Authority of India (IRDAI) chairman launched more ‘day-care’ based covers on health insurance policies to offer more protection to the insured financially. Read this post below to know why day-care procedures are important to have in health insurance policies.

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What are the Day-Care Coverage in Health Insurance Policy?

The day-care coverage may include the following:-

  1. Chemotherapy
  2. Radiation
  3. Dialysis
  4. Cataract
  5. Lithotripsy
  6. Tonsillectomy
  7. Appendectomy
  8. Angiography
  9. Prostate
  10. Sinusitis
  11. Liver aspiration

You can know your covered day-care treatments in the policy documents.

Which are the Top Health Insurance Companies offering Day-Care Procedures?

The list includes Star Health, Bajaj Allianz, HDFC Ergo, etc.

Star Health and Allied Insurance Co Ltd

The insurance company offers you a Family Health Optima Insurance Plan under which all the specific injury, illness, critical illness and all day procedures are covered. It is an affordable health insurance plan and you can pay the premium in Monthly, Quarterly, Half-yearly, or Annually whichever is suitable for you. The insurer covers the insured against future health risks with a sum insured of INR 4 lakh-25 lakh.

ICICI Lombard General Insurance Company Limited

The insurance company covers the following list of day-care treatment under the health insurance policy:-

Operations on the Eyes

  1. Tear glands incision
  2. Other operations on tear ducts
  3. Diseased eyelids incision, excision & destruction
  4. Canthus and Epicanthus Operation
  5. Entropion & Ectropion corrective surgery
  6. Blepharoptosis corrective surgery
  7. Conjunctiva removal of a foreign body
  8. Cornea removal of a foreign body
  9. Cornea incision
  10. Pterygium and other operations of the cornea
  11. Eye lens, posterior chamber, orbit and eyeball removal of a foreign body
  12. Cataract operation

Operations on the Nose & Nasal sinuses

  1. Diseased tissue excision and destruction of the nose
  2. Turbinates operations
  3. Other operations of nose
  4. Nasal sinus
  5. Removal of a foreign body from the nose

Microsurgical operations on the middle ear

  1. Stapedotomy
  2. Stapedectomy
  3. Stapedectomy revision
  4. Auditory ossicles other operations
  5. Myringoplasty
  6. Tympanoplasty
  7. Tympanoplasty revision
  8. Microsurgical operations on the middle ear

Other operations on the Middle & Internal Ear

  1. Myringotomy
  2. Removal of a tympanic drain
  3. Middle ear mastoid process and incision
  4. Mastoidectomy
  5. Reconstruction of the middle ear
  6. Other excisions of the middle and inner ear
  7. Fenestration of the inner ear
  8. Revision of fenestration of the inner ear
  9. Inner ear incision and destruction (opening and elimination)
  10. Other operations on the middle and inner ear

Operations on the Tongue

  1. Diseased tissue of the tongue incision, excision and destruction
  2. Partial glossectomy
  3. Glossectomy
  4. Reconstruction of the tongue
  5. Other operations on the tongue

Other Operations on the mouth & face

  1. Mouth, jaw and face external incision and drainage
  2. Hard and soft palate incision
  3. Diseased hard and soft palate excision
  4. Mouth incision, excision and destruction
  5. Mouth floor plastic surgery
  6. Palatoplasty
  7. Mouth other operations

Operations on the tonsils & adenoids

  1. Pharyngeal abscess transoral incision and drainage
  2. Adenoidectomy with or without Tonsillectomy
  3. Lingual tonsil excision and destruction
  4. Other operations on the tonsils and adenoids

Operations on the salivary glands & salivary ducts

  1. Salivary gland and salivary duct incision and lancing
  2. Diseased tissue of a salivary gland and salivary duct excision
  3. Resection of a salivary gland
  4. Reconstruction of a salivary gland and a salivary duct
  5. Salivary glands and salivary duct other operations

Operations on the Breast

  1. Breast incision and nipple operation

Operations on the Skin & Subcutaneous Tissues

  1. Pilonidal sinus incision
  2. Skin and subcutaneous tissues other incision
  3. Surgical wound
  4. Removal of diseased tissue from skin and subcutaneous tissues
  5. Diseased tissue of the skin and subcutaneous tissues local excision
  6. Skin and subcutaneous tissues other excision
  7. Continuity of the skin restoration
  8. Subcutaneous tissues
  9. Skin transplantation both donor and recipient site
  10. Skin plasty revision
  11. Skin and subcutaneous tissues other restoration and reconstruction
  12. Skin Chemosurgery
  13. Skin and subcutaneous tissues destruction (diseased tissue)

Operations on the digestive tract

  1. Perianal region excision and incision
  2. Anal fistulas surgical treatment
  3. Haemorrhoids surgical treatment
  4. Anal sphincter (sphincterotomy) divison
  5. Anus other operations
  6. Ultrasound
  7. Sclerotherapy

Operations of bones and joints

  1. ligament tear surgery
  2. Meniscus tear surgery
  3. Hemarthrosis or pyo arthritis surgery
  4. Fracture pins or nails removal
  5. Metal wire removal
  6. Fracture, luxation closed reduction
  7. Dislocation under GA
  8. Osteosynthesis with epiphyseolysis
  9. Trauma and orthopaedics surgery
  10. Bone, septic and aseptic incision
  11. Fracture, luxation or epiphyseolysis with osteosynthesis closed reduction
  12. Tendons and tendon sheath suture and other operations
  13. Knee aspiration (arthroscopic)

Operations on Female sexual organs

  1. Ovary incision
  2. Fallopian tubes insufflation
  3. Fallopian tube other operations
  4. Cervical canal dilation
  5. Uterine cervix conization
  6. Uterine cervix other operations
  7. Uterus (hysterotomy) incision
  8. Therapeutic curettage
  9. Culdotomy
  10. Vagina incision
  11. Vagina and the pouch of Douglas local excision and destruction of the diseased tissue
  12. Vulva incision
  13. Bartholin’s glands (cyst) operation

Operations on Prostate & seminal vesicles

  1. Prostate incision
  2. Prostate tissue transurethral excision and destruction
  3. Prostate tissue transurethral and percutaneous destruction
  4. Prostate tissue open surgical excision and destruction
  5. Radical prostatovesiculectomy
  6. Prostate tissue other excision and destruction
  7. Seminal vesicles operation
  8. Periprostatic tissue incision and excision
  9. Prostate other operations

Operations on Scrotum & Tunica Vaginalis Testis

  1. Scrotum and tunica vaginalis testis incision
  2. Testicular hydrocele operation
  3. Scrotal tissue excision and destruction (diseased tissue)
  4. Scrotum and tunica vaginalis testis plastic reconstruction
  5. Scrotum and tunica vaginalis testis other operation

Operations on Testes

  1. Testes incision
  2. Testes excision and destruction of diseased tissue
  3. Unilateral orchiectomy
  4. Bilateral orchiectomy
  5. Orchidopexy
  6. Cryptorchidism abdominal exploration
  7. Abdominal testis surgical repositioning
  8. Testis reconstruction
  9. Testicular prosthesis implantation, exchange and removal
  10. Testis other operations

Operations on Spermatic Cord, Epididymis and Ductus Deferens

  1. Varicocele and hydrocele of the spermatic cord surgical treatment
  2. Epididymis area excision
  3. Epididymectomy
  4. Spermatic cord reconstruction
  5. Ductus deferens and epididymis reconstruction
  6. Spermatic cord, epididymis and ductus other operation
  7. deferens

Operations on the Penis

  1. Foreskin operation
  2. Diseased tissue of the penis local excision and destruction
  3. Amputation of the penis
  4. Plastic reconstruction of the penis
  5. Other operations on the penis

Operations on the urinary system

  1. Cystoscopic removal of stones

Other Operations

  1. Lithotripsy
  2. Coronary angiography
  3. Haemodialysis
  4. Radiotherapy for Cancer
  5. Cancer Chemotherapy
  6. Endoscopic polypectomy

So, if you want coverage for the above mentioned day-care surgeries, you can buy a health insurance policy from ICICI Lombard General Insurance Company Ltd.

Bajaj Allianz General Insurance Company

To avail the day-care procedure benefits on your Bajaj Allianz insurance, you need to submit the day-care procedure claim form with the duly filled details to the company or TPA. You have to submit all the necessary bills and other documents to claim reimbursement from the insurer.

For a planned day-care procedure, you should submit a notice to Bajaj Allianz General Insurance Company, and proceed with the cashless facility for a hassle free treatment. The day-care cover may vary depending on your Health Plan. You can get Daycare cover for several procedures from Bajaj Allianz policies, which are not limited to –

  1. Ear operation
  2. Nasal surgery
  3. Orthopaedic procedures
  4. Optical surgery
  5. Chemotherapy
  6. And other Oncological procedures

HDFC ERGO Health Insurance Ltd

When the insured visits a clinic, hospital, or an associated facility like a consultation on the advice of a Medical Practitioner. In this case, the insured is not admitted as a day-care or in-patient, so it is not covered under the policy. Pre and post hospitalization expenses for consultations, investigations and medicines which are incurred upto 60 (pre-hospitalization) and 180 days (post-hospitalization) before the date of admission to the hospital as an inpatient, Day-Care, or Domiciliary treatment are covered by the HDFC ERGO Health Insurance Ltd.

It includes the medical treatment or surgical procedure which is undertaken under general or local anaesthesia, in a Hospital or Day-Care Centre for less than 24 hours.

The indicative list of Day-Care Procedures Covered by the Insurer are:-

  1. Cancer Chemotherapy
  2. Liver biopsy
  3. Coronary angiography
  4. Haemodialysis
  5. Operation of cataract
  6. Nasal sinus aspiration

How to Compare a Day-Care Cover?

You should check the policy document first before you buy the policy and compare the same with other policies to make it clear which one is the best for you. The broader the definition of the covered day-care procedure is the better it is. Because in some policies, the company offers to pay for eye correction surgery, without any definition of the specified illnesses. As a result, several ailments are not covered in the day-care procedure.

Points to Remember While You are Buying a Policy

  1. Treatments taken by the out-patient department (OPD) should not be considered as Day-Care Treatments. For instance, a dental clean up is an OPD procedure whereas a dental surgery is a day-care procedure. There is a fine line in Day-Care treatments and OPD which you must know.
  2. The claim procedure for Day-Care procedures must be the same as the regular hospitalization. Inform the respective TPA about the day-care treatment in advance in case it is a planned surgery. In the case of an emergency, inform the TPA within the first 24 hours of admission.
  3. Never buy a health insurance policy only because of day-care procedure
  4. Always read the policy document carefully and consider all possible parameters

Note: Day-care procedures do not cover cosmetic surgeries unless they are required for the maintenance of one’s life and are expressly prescribed by a healthcare professional.

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