Health Insurance November 4, 2020

What is the Difference Between Daycare Treatment and OPD Treatment?

Many don’t understand the technicalities of a Health Insurance Plan, one of which is ‘Policy Wordings’. The wordings include the Terms & Conditions and definitions of the coverage of a health insurance plan. The habit of agreeing to tick ‘YES’ to the ‘Terms and Conditions’ has been so deeply rooted in us that we blindly trust the broker or agent when it comes to the technicalities of the Health Insurance Plan, and don’t read those. One such technical thing is the difference between the Daycare Treatment and OPD Treatment that a lot of people don’t know.

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Many people like to believe that Daycare Treatments and Outpatient Department (OPD) Treatment are the same. If you also think that way, we are here to break your long-held belief. There are several differences between the Daycare treatment and OPD Treatment in a Health insurance plan.

So what are these differences? We will discuss the same in this article. We will also tell you what exactly is the Daycare Treatment and OPD Treatment so that you can understand better. Let’s start!

What Exactly is the Daycare Treatment?

Before understanding the basics of the Daycare Treatment, you should first know that If you want to claim the hospitalization expenses under your policy, you should be admitted to a hospital for a minimum of 24 hours. Without this, you cannot claim the In-patient Hospitalization Expenses under your Insurance Plan. But you must have noticed around yourself that medical technology has progressed at a rate that we didn’t imagine a few years ago. The treatments that used to take days can now be done in a few hours and patients can get discharged from the hospital the very same day.

Let’s suppose you get admitted to the hospital for eye surgery, but you got discharged the same day. So, would you be able to get claims for this as you didn’t complete the 24 hours of Hospitalization? Well, the answer to this question is YES! Treatments that do not require 24-hours of Hospitalization due to medical advancements come under the Daycare Treatments, and you will get coverage under your Policy. However, not every daycare procedure may be covered in the policy. It further reinforces the importance of reading the policy documents carefully before accepting an insurance plan. But a few common daycare treatments which are covered by most, if not all, are as follows.

  1. Eye Surgery such as Cataract surgery
  2. Radiotherapy and Chemotherapy
  3. Tonsillectomy
  4. Bone fracture and joint-related surgeries
  5. Certain injury-related Dental Surgeries
  6. Coronary Angiography
  7. Nasal Sinus Aspiration
  8. Removal of a Foreign Body from the Nose

What Exactly is the Outpatient Department (OPD) Treatment?

Outpatient Department or OPD Treatments are those treatments where individuals don’t need to get admitted to a hospital. Let’s understand it in a simple manner! Suppose you have an ailment or disease for which you only need to visit the clinic of the Doctor or Medical Practitioner for the treatment or diagnosis. This type of treatment is known as OPD Treatment. We promised to talk about the difference between the Daycare Treatment and OPD Treatment, but can you see a similarity between these two treatments? Well, the treatment time in both of the methods is low.

One of the perfect examples of OPD Treatment would be Root Canal Treatment, where a person only needs to visit the Doctor’s clinic where he/she can get the treatment without being admitted. So, this comes under as an OPD treatment.

Differences Between Daycare Treatment and OPD Treatment

Now that you have understood what exactly is Daycare Treatment and OPD Treatment and what is the one similarity between them, you should know the factors that differentiate both. These factors are the Availability of Coverage, the  Coverage Limit, the Claim Settlement Process, etc. We are showing these factors in detail below. Please have a look!

Coverage Availability

The first difference between the Daycare Treatment and OPD Treatment is the availability of coverage in your Health Insurance Plan. The facility of Daycare Treatment is available in almost all the Health Insurance Plans provided by different insurance companies. Irrespective of the type — whether it is a basic plan or a comprehensive one, individuals get Daycare treatment facilities in their insurance scheme. You can consider the Daycare treatment as the standard coverage feature of all Health Insurance Plans.

On the other hand, OPD treatment is not standard across all the Health Insurance Plans. It is possible that a policy offering Daycare Treatment may not offer OPD Coverage to you. OPD Treatments are generally excluded from many health insurance plans. So, if an OPD coverage is an absolute necessity for you, read the Policy document with an open mind and choose accordingly. Insurance Plans that include OPD coverage may have higher insured limits, and you may need to pay a higher premium amount too. Some Health Insurance Plans also offer OPD Coverage on paying an extra premium. But anyways, OPD Coverage is not a universal feature across Health Plans.

Coverage Extension: How Much will the Treatment Cover?

As we said earlier, Daycare Treatment is one of the standards and universal features across Health Insurance Plans, and how OPD Treatment is not. This factor also affects your coverage for Daycare Treatment and OPD Treatment. A Health insurance Plan covers almost all the Daycare Treatments (barring a few treatments like Cataract) up to the Sum Insured, which means there are no limits on the Daycare Treatment within your sum insured limit. Remember that the number of daycare treatments may vary from one plan to another.

On the other hand, OPD Treatments get coverage only within a sub-limit of your overall sum insured limit, which means you will not be able to get the full claim in the case of an OPD Treatment. Expenses incurred on OPD Treatments should be within this particular limit fixed by the Insurance Company. Over this limit, you will have to pay from your pocket. This sub-limit may vary from one insurance plan to another, and the amount is much lower than the sum insured.

Claim Settlement Process

Coming to the most crucial difference between the Daycare Treatment and OPD Treatment, which is the Claim Settlement Process for both these treatments. In a Daycare Treatment, you have the option to choose between the Cashless and Reimbursement Claim method. However, this is not the case with OPD Treatment. Here, you can only choose the Reimbursement method.

You can consider the Claim settlement process of both Daycare Treatment and OPD Treatment as the process in a Regular Hospitalization. As we also said earlier that almost all daycare treatments are pre-planned, individuals have the option of enjoying the benefits of a Cashless method in a Network Hospital of your Insurance Company. For this, the person only needs to intimate the TPA. In case you get admitted to a Non-network Hospital, you can always get Reimbursement after getting discharged from the hospital. For this, you will need to submit a few documents within a fixed time frame as set by your Insurance Company.

As you would know a person does not need to be admitted to a hospital to get the  OPD Coverage. Due to this, the Cashless method of raising Claims is out of the equation. You can only opt for a Reimbursement Facility. OPD Coverage usually works like Indemnity-based Health Insurance Plans where you will need to pay for all your medical expenses. Later, you can get all reimbursed by submitting the necessary documents such as Bills, Receipts, etc. Once you submit all the documents, the Insurance Company will verify the claim and reimburse the amount within the sub-limit decided by the company.

Now that you know the differences between the Daycare Treatment and OPD Treatment, you should not find it hard to understand technical terms related to a health insurance plan. All these can prove crucial when you choose a suitable Health Insurance Plan for yourself.

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