Day Care Procedures Covered under Health Insurance

Most of the health insurance companies offer coverage for day care procedures. However, it is necessary to the insured to check the company’s policies to understand the type of procedures covered by a policy.
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Health insurance policies are slowly becoming the norm, with a number of Indians buying these policies to offset the high costs of healthcare. While most health insurance policies cover major surgeries and hospital stays, there are also shorter, day care procedures that can be claimed under your health insurance policy.

Day Care procedure is Covered in Health Insurance

What is a Day Care Procedure?

A day care procedure is a surgery or medical procedure that formerly required a prolonged stay in hospital but can now be completed in less than 24 hours. Thus, while the patient is in hospital for a short period of time, he/she does not spend a full 24 hours in the hospital, which is the minimum period for which claims can be filed.

Day care procedures are surgeries or procedures that no longer require extended periods of hospitalisation thanks to advances in medicine and technology. However this does not prevent them from being a drain on the patient’s finances. In fact, the cost of these procedures after factoring in medical tests and medications could add up to a large sum of money.

In light of this, health insurance companies have made it possible for policyholders to file a claim in the event they have to undergo such a procedure, thus bypassing the 24 hour hospitalisation rule.

List of Day Care Procedures:

Operations Procedures/Inclusion
Eyes
  • Cataract operation.
  • Removal of foreign body.
  • Corneal incision.
  • Tear duct operations.
  • Eyelid incision.
  • Corrective surgery for entropion, ectropion.
Nose and Sinus
  • Nasal sinus aspiration.
  • Operation on nasal concha.
  • Other operations on the nose.
  • Foreign body removal.
Ear
  • Stapedotomy.
  • Stapedectomy.
  • Operations on the auditory ossicles.
  • Tympanoplasty.
  • Operations on the middle ear.
  • Reconstruction of the middle ear.
  • Incision of the inner ear.
  • Other operations on the inner ear.
Tongue
  • Reconstruction of the tongue.
  • Glossectomy.
  • Other operations on the tongue.
Bones
  • Ligament tear and meniscus tear surgery.
  • Orthopaedics and trauma surgery.
  • Fractures and sutures on tendons.
  • Dislocation surgery.
  • Other joint and bone surgery.
Skin and subcutaneous tissue
  • Skin transplantation and restoration.
  • Chemosurgery to skin.
  • Incisions to skin and subcutaneous tissue.
  • Excision of diseased skin and subcutaneous tissues.
Face
  • Plastic surgery to the mouth.
  • Incisions to the mouth, jaw and face.
  • Other operations to the mouth and face.
Other operations
  • Lithotripsy.
  • Coronary angiography.
  • Haemodialysis.
  • Radiotherapy (for cancer).
  • Chemotherapy.

Additionally, surgeries performed on the digestive tract, male and female reproductive organs are also covered.

Things to Keep in Mind:

Day care procedures are covered subject to them being in the by the particular insurance company. When looking for policies that cover day care procedures, it is advisable to look for ones that cover a broad range of categories instead of ones that list specific procedures as the broad categories generally cover a lot more surgeries and procedures.

Filing a Claim for Day Care Procedure:

When filing a claim for a day care procedure, the policyholder can follow the same process as a regular health insurance claim as day care procedures are a part of the protection provided under the health insurance policy.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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