Day Care Treatment are covered under group health insurance

Day care treatment refers to medical procedures that do not require you to stay in the hospital overnight. Typically, these treatments take less than 24 hours from admission to discharge. Thanks to modern medical technology, many conditions can now be treated this way, making healthcare more convenient and often less expensive.

For example, let's say you need cataract surgery. In the past, this might have required a hospital stay of several days. Now, with day care treatment, you can arrive at the hospital in the morning, have the surgery, and be back home by evening. This is not only more convenient for you but also reduces the overall cost of the procedure.

Group insurance plans have changed a lot over time. Now, many of them cover day care treatments. This is a big plus for employees. Group health insurance policies, which employers often provide, have evolved to include coverage for day care treatments.

This is great news for employees, as it means more comprehensive protection for various medical needs. This coverage in group insurance plans helps with a wide range of medical needs. It can save you money and stress when you need quick medical care. Overall, it's a valuable part of modern group insurance health.

Also Read: Health Insurance Coverage for 15 Common Daycare Procedures

Cost-Effective: Day care treatments are usually less expensive than inpatient procedures. For instance, a day care procedure for removing kidney stones might cost 30-40% less than if it required an overnight stay.

Quicker Recovery: Patients can return home sooner, which can aid in faster recovery. Being in a familiar environment often helps people feel better more quickly.

Less Disruption: Shorter hospital stays mean less disruption to your daily life and work. You might only need to take a day or two off work instead of a week or more.

Reduced Risk of Hospital-Acquired Infections: Day care procedures are often less invasive. Less time in the hospital means lower chances of catching an infection during your stay.

Better Utilisation of Hospital Resources: Day care treatments free up hospital beds for patients who need long-term care.

While the specific day care treatment disease list may vary between insurance providers, here are some commonly covered procedures:

• Eye surgeries (e.g., cataract removal, glaucoma surgery)

• Dental surgeries (e.g., root canal, wisdom tooth extraction)

• Chemotherapy sessions for cancer treatment

• Dialysis for kidney patients

• Tonsillectomy (removal of tonsils)

• Lithotripsy (treatment for kidney stones)

• Arthroscopy (minimally invasive joint surgery)

• Angiography (examination of blood vessels)

• Radiotherapy for cancer treatment

• Minor skin surgeries

If you want a full list of all the day care procedures your insurer covers, it is best to check their policy documents. You can find Tata AIG’s IRDAI day care procedure list on our website.

Financial Protection: Even though day care treatments are shorter, they can still be expensive. Insurance coverage helps manage these costs.

For example, a day care procedure like arthroscopy can cost anywhere from ₹50,000 to ₹1,50,000, depending on the hospital and location. Having this covered by insurance can save you from a significant financial burden.

Wide Range of Treatments: Covered medical requirements include minor surgeries and cancer treatments. This comprehensive coverage ensures that you're protected for many different health scenarios.

Convenience: You can get necessary treatments without extended hospital stays. This is especially helpful for people who are often busy or who don't feel safe in hospitals.

Peace of Mind: Knowing you're covered for these procedures can reduce stress about potential health issues. You can focus on getting better without having to worry about money.

Faster Access to Treatment: Since day care treatments often have shorter waiting times than inpatient procedures, you can get the care you need more quickly.

If you need a day care treatment:

-Check Your Policy: Review your group mediclaim policy to confirm coverage. Look for a section specifically mentioning day care treatments or procedures.

-Choose a Network Hospital: Often, using a hospital in your insurer's network can make the process smoother.

-Inform Your Insurer: Many insurance companies require pre-authorization for day care treatments. This usually involves submitting a form with details about the proposed treatment. Your HR department or insurance provider can guide you through this process.

-Follow the Claim Process: You can either choose a cashless claim or a reimbursement claim. Your HR department can guide you on the specific steps for claiming.

Generally, for reimbursement claims, you'll need to submit:

• Filled claim form

• Original bills and receipts

• Doctor's prescription and diagnosis

• Any investigation reports

• Discharge summary from the hospital

For cashless claims, you will only need to contact us (48 hours for planned hospitalisation and 24 hours for emergencies) and present your provided ID card to the hospital/TPA along with any documentation requested.

-Keep All Documents: Make sure to keep copies of all documents related to your treatment and claim. These might be needed if there are any queries about your claim.

While day care treatment in group health insurance is beneficial, keep these points in mind:

-Coverage Limits:: There may be caps on how much the insurance will pay for specific treatments. For example, your policy might cover day care treatments up to ₹50,000 per year.

-Waiting Periods:: Some plans make you wait a certain amount of time before you can file a claim for certain day care services. This is especially common for pre-existing conditions or critical illnesses.

-Exclusions:: Certain treatments might not be covered, so always check your policy details. For instance, cosmetic surgeries are often excluded from day care coverage.

-Co-Payment:: Some policies might require you to pay a percentage of the treatment cost. This is called co-payment and is usually around 10-20% of the total cost.

-Room Rent Limits:: Even for day care treatments, some policies might have limits on the type of room you can use. Exceeding this limit could mean paying the difference out of pocket.

Also Read: What Is the Difference Between OPD Treatment and Day Care Treatment?

To get the most out of your day care treatment coverage in group health insurance:

• Keep yourself updated about the day care treatments covered under your policy. Your HR department or insurance provider should be able to provide you with a comprehensive list.

• If you know you'll need a day care procedure, check your coverage and plan accordingly. This could avoid unexpected expenses.

• Adhere to your insurer's guidelines for pre-authorisation and claims to avoid issues. Missing a step in the process could result in claim rejection.

• Maintain all medical and financial documents related to your day care treatment for smooth claim processing. This includes prescriptions, diagnostic reports, bills and receipts.

• Whenever possible, opt for hospitals in your insurer's network. This usually makes the claims process much smoother for you.

• Many day care treatments are for conditions that can be detected early through regular check-ups. Catching health issues early often means simpler, less expensive treatments.

Day care treatment coverage in group health insurance is a valuable benefit that can impact employee healthcare experience and their finances. By understanding what's covered, how to claim benefits, and staying informed about the day care treatment disease list, you can ensure employees make the most of this coverage.

As an employer, business insurance in India, like group health insurance, protects both your business and your employees. This is why TATA AIG offers several group insurance plans.

What is covered in group health insurance?

Group insurance for health typically covers hospitalisation expenses, pre and post-hospitalisation costs, day care procedures and sometimes critical illnesses. It often includes coverage for room charges, doctor fees, medicines and diagnostic tests. Many plans also offer maternity benefits and emergency ambulance services.

Is OPD covered in group health insurance?

OPD (Outpatient Department) coverage in group health insurance varies by policy. Some group plans include OPD benefits, covering expenses like doctor consultations, diagnostic tests and medicines. However, many basic group health policies don't cover OPD. It's often available as an add-on feature.

Is day care treatment and OPD same?

No, day care treatment and OPD are not the same. Day care treatments are procedures requiring less than 24 hours of hospitalisation. OPD refers to consultations and treatments where patients aren't admitted to the hospital.