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.
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.
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 list of procedures covered 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.
I got group insurance from company, on time I got policy. My father was not good at the time I have used the policy. I got the reimbursement around Rs. 23,000 the total value is Rs. 33,000. I went to shobha hospital they don't have tie up with United India, hence I got the reimbursement.
I have medical cover with Max bupa, they gave me the coverage value of Rs. 5 lakhs its covers for entire family. One time I claimed for my mother for the eye surgery, I got the reimbursed within 30 days with 90% of amount, the total experience was good.
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SREERAMULU GOPANNAGARI
, hyderabad
Reviewed on Jan 18, 2019
My company has provided me a health insurance policy from new India. As per company norms, they have given me a coverage value of Rs. 5 lakhs. My entire family has been covered in this policy. They are offering a cashless treatment facility.
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KODIHALLI VIRUPAKSHAPPA VIRUPAKSHAPPA DHANANJAYAMURTHY
, bangalore
Reviewed on Jan 18, 2019
I had taken this insurance policy in the year of 2018 and the the premium has been deducting from my salary. The premium amount has not been too high and there has been many hospitals collaborated within my locality. There has also been some cashless treatment available with this policy as well.
I have my health insurance with Star health insurance, i had claim experience with it, my experience was good, they have good tie up with my hospital and they have mailed me about the location of it, and i am happy with there service, they have charged me premium amount on yearly basis, and the premium amount is nominal for me, and i use to pay through on line mode.
I have taken my health insurance with Max BUPA , i have not opt there policy yet and i use to pay premium on monthly bases , and it use to get auto debit from my account and while i applied for health insurance customer service had explained me about all procedure , so far the process went smoothly and it good.
I got the health insurance with Max bupa health insurance, there service is good, they have charged me premium nominal ,and the premium is on yearly basis, and they have tie up with many hospital , and had shared the details via mail, and i pay premium amount through on line mode.
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NIRANJAN KUMAR DAS
, new delhi
Reviewed on Jan 17, 2019
I got the health insurance with HDFC Ergo, they got tie up with many hospitals, and they have shared me location on those hospital in mail, and they have charged me nominal premium amount ,they have charged me up to 17000-18000 as premium, it is on yearly basis, and i use to pay the premium on an on line basis.
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0
JILLIAN ANTOINETTE DOUGHERTY
, bangalore
Reviewed on Jan 17, 2019
I got the health insurance with SBI, they got tie up with many hospitals. I Felt the medical cover its less and i am not happy with there support team ,like if i want to call the customer care there number would not be reachable and they use to mail me PDF after paying premium amount,it would not get open, they have charged me premium amount on yearly basis,i have bad experience with this bank.
I have a health insurance from HDFC ERGO which was purchased by me in the year of 2018 because the benefits are very good. The claim process was simple and they have more number of hospitals for cashless. I have paid 18,800 for one year and took 3 years policy for myself and my wife. The medical coverage is 10L for myself and 5L for wife.
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2
SHEKHARAPPA SHASHIDHAR
, bangalore
Reviewed on Jan 14, 2019
I have taken health insurance from HDFC Ergo which was offered along my personal loan. I have received the insurance paper and its been couple of months. It covers critical illness and need to go through the policy benefits. Always the customer is good.
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SRIDHAR A ANANTHA PADMA NAGAV RAV
, bangalore
Reviewed on Jan 14, 2019
I have taken health insurance from tata aig. I did take health insurance from tata aig for my parents and The Process was so simple. Customer representative is good. The customer service and response was on time, never had any issues. Now I feel safe for my family
Thank you tata aig.
This policy was part of my employment, I took the medical coverage of Rs. 5 lakhs for the tenure of one year, this medical benefits for my entire. They have good networks of hospital with major disease cover. But I think it doesn't have no claim bonus.
For my spouse operation I used the health policy, I approached them for the claim through hospital. I submitted the form and they send the papers to the Reliance insurance company. I got the cash less treatment, but I paid some amount which was not covered. But they gave me the on time approval.
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1
LALIT KUMAR SARAOGI
, kolkata
Reviewed on Jan 11, 2019
On time Cigna TTK have activated the policy which provided by the company, the policy which I hold it has the coverage of Rs. 4 lakhs its covers for me. They are providing coverage for the pre existing with the tax benefits but there is no claim.
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1
TIMMAYYA MANIKANTHAKUMAR
, dandeli
Reviewed on Jan 10, 2019
In Cigna TTK, they are providing pre existing disease cover, but they don't have no claim bonus features. The response is good they have good customer care working 24/7 , the medical coverage is good for me and entire family. They have many hospital which they got tie up in Mumbai.
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0
PARAMASIVAM SHOWKARTHIK
, mumbai
Reviewed on Jan 10, 2019
I had taken this insurance policy a while back and i had been paying the premium amount on an annual basis. The premium method has been convenient and the premium amount has not been high. There has been many hospitals covered in my locality and their customer support has also been helpful.
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2
ABHILASH GAJANAN TELANG
, pune
Reviewed on Jan 09, 2019
My organization has provided me a health insurance with ICICI Lombard. I have not claimed anything from this policy. My entire family has been covered in this policy. They have given me a coverage value of Rs. 3 lakhs. This is a cashless policy.
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ASHISH SHARMA
, new delhi
Reviewed on Jan 09, 2019
My company has offered a health insurance from Star Health with the coverage of 1L, its for the family, Still I have not used the policy and am gone utilize the policy within 15 days for my family.They covers a major disease. I have called the customer service and the response is good. I am planning to go for reimbursement, they do have minor network of hospitals for cashless. I can recommend after completing my claim.
My company has provided me a health policy from National insurance with the coverage of 2L. It is for the family members and no claim. I never contacted the customer service. Every year it was renewed by the company. They have limited networks of hospitals for cashless. It does not cover only eye problems, if we got admitted in hospital for 24hrs then applicable for claim.
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