Day care Treatment include:

Chemotherapy
Eye Surgery
Appedectomy
Dialysis
Radiotherapy

What is Inpatient Treatment?

Inpatient treatment is a type of treatment in which a patient is provided with 24
hour care at a live-in facility. Both psychiatric and physical health assistance are
included in this treatment. In most cases, patients will stay at inpatient treatment
facilities for months at a time. Before becoming accepted to this type of high-
maintenance treatment, various assessments must be taken.
One important difference in inpatient treatment when compared to outpatient
treatment is the amount of medical attention received by a patient. In inpatient
treatment, constant medical supervision is placed over each resident. Also,
detoxification is provided in many inpatient drug treatment centers. In the case of
someone with an eating disorder, inpatient treatment through an eating disorder
residential program will be more effective in monitoring positive or negative health
levels. If the health of a person is declining, the facility can appropriately take care of
the person, providing them with care from a local hospital if necessary.
Inpatient care may be more effective because it offers a very structured and defined
atmosphere. This type of a setting helps a person to forget about the distractions of life
and allows them to focus on physical and psychological healing. Inpatient pain
treatment, treatment for alcoholism or drug abuse, and eating disorder treatment are a
few popular types of inpatient treatment.

What Day Care Procedure is

Covered in Health Insurance?
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Due to the technological advancements in medicinal industry, a host of surgeries and

procedures that earlier required prolonged or at least a day’s hospitalisation can now
be completed in less than 24 hours. This short-term hospitalisation procedure is
called a ‘Day Care Procedure’.

A common assumption is that standard health insurance policies only cover expenses
incurred towards expensive treatments pertaining to critical illnesses, requiring an
extended hospital stay. However, the fact is that most health insurance providers
cover day care procedures as well.
Some health insurance providers cover limited day care procedures, others cover almost
all day care procedures. Day care procedures include cataract, radiotherapy,
chemotherapy, dialysis, angiography, tonsillectomy, lithotripsy, etc.
The list of the exact day care procedures covered is included in the insurance policy
documents and can be found on the company’s website as well. The list of day care
procedures is likely to grow in the near future.

Advantages of Day Care Health Insurance

Despite the fact that most day care procedures do not require extended
hospitalisation, they still turn out to be expensive. Even over -the-counter expenses
like diagnosis tests not requiring hospitalisation/treatment can cost a bomb. This is
where day care health insurance saves the day.

Example 1: Mr. Verma was diagnosed with kidney stones and a specialist advised
lithotripsy for the stones’ removal. Earlier, the patient needed to be hospitalized to
undergo this surgery. But due to medical advancements, this surgery now lasts only
for a few hours and the patient is discharged the same day.
Mr. Verma holds a health insurance policy that includes cover for day care
procedures. He scheduled the surgery for a later date and took the necessary steps to
avail cashless services. The cashless payment procedure was smooth and Mr.
Verma’s health insurance provider approved the treatment costs without any hassles,
as lithotripsy was covered under the insurance company’s listed day care procedures.

Example 2: Mr. Singh met with an accident and required a Septoplasty (surgical
procedure to correct nasal septum displacement). The surgery expenses worked out
to a whopping INR 60, 000 Mr. Singh underwent the Septoplasty surgery successfully
and went home the very same day. Thanks to the day care insurance cover in his
health insurance policy, he was able to pay for the Septoplasty without any financial
stress.
How to Choose Day Care Health Insurance Plan?
Most health insurance companies highlight the “number” of day care procedures
covered under their policy to entice customers. As a result, nov ice health insurance
buyers wrongly choose a health insurance plan with maximum day care procedures.

However, the number of day care procedures listed in the medical insurance plans is
not the only factor that one must consider before investing. Cashless facility, age
limit, sub limit, co-pay, etc. all play an important role in a health insurance
policy.

Your health insurance advisor’s advice, and visiting the website of dedicated brokers
and asking for expert opinions could aid in buying a health insurance plan best suited
to your requirements.

Quality Vs. Quantity

It is advisable to see the treatments covered under the day care procedures in a
broader ‘concept’ sense. For instance, instead of looking at 200+ names of various
isolated surgeries, looking at 20-30 broader categories like urology, oncology, etc.is a
more practical, beneficial and inclusive approach, as hundreds of procedures are
covered under these broad umbrellas.
Moreover, for all practical purposes, it is better to opt for the broader catego ries that
even a layperson can understand. Further, an insurance company that gives a
detailed list with specific procedures may refuse to cover new treatments that come
up in future due to medical science advances.

When comparing different plans with similar features and benefits, it is wiser to opt for
the one with broader categorization or better yet, with all -inclusive day care
procedures.

Category Cover
Public sector insurers usually list out the broad categories of day care procedures.
The advantage is that if a particular category of day care procedure is not listed at the
time of policy purchase, one can request for its inclusion to third party administrators
prior to treatment commencement.

Process of Filing Day Care Claims in Health Insurance

The process for filing day care claims is similar to that of a regular health insurance
policy, since day care procedure coverage is an in -built policy feature. In case of
planned procedures, the cashless route can be availed - some companies need prior
intimation.

In other cases, insurers reimburse after submission of the required documents. The
provisions for pre and post hospitalisation benefits also remain same - the insurance
company reimburses hospitalisation expenses incurred by the policyholder.

Some Treatments Included in Day Care Procedures

Type of treatment Details

Nose, nasal sinuses Procedures on the turbinates, Excision and destruction of infected tissue of the n
sinus aspiration

Ear operations Reconstruction of the middle ear, Reconstruction of the auditory ossicles, Fenes
inner ear, Removal of a tympanic drain, Tympanoplasty (eardrum perforation clo

Orthopedics Arthroscopic knee aspiration, Osteosynthesis, Incision on bone - aseptic and sep
other procedures on tendons/tendon sheath

Opthalmology Cataract, Excision and destruction of infected tissue of the eyelid, Incision of tea
Incision of the cornea, Retinal detachment surgery, Procedures on the epic anthu
Foreign body removal from the cornea, conjunctiva, eye lens, etc.

Treatment of Free skin transplantation,Chemosurgery to the skin, Revision of skin plasty, Loc
subcutaneous tissues destruction of diseased tissue of the skin
and skin

Day care procedures also include heart and cancer treatments, urinary and sexual organs.
* The above list is indicative. Policies offered by different insurance companies may
have specific inclusions and exclusions.

Pre-hospitalization Expenses
When one falls sick, one usually consult a family physician and gets relevant
investigations done. On the advice of the physician, one gets hospitalized for
further management of the disease if required. Such
medical expenses incurred before hospitalization are called Pre-
Hospitalization expenses.

Often hospitalization is required after a series of tests and treatments have already been
performed without improvement in the patient’s condition. Also, similar expenses will be
incurred after the patient has been discharged from the hospital. Most individual and
group health insurance plans have provisions to cover such expenses.

Pre-hospitalization expenses refer to the expenses incurred before a patient is

moved to a hospital for inpatient treatment. Following expenses can be considered as
part of the pre-hospitalization expense in a health insurance policy:

 Medical Tests

 Medicines

 Vaccinations

 Doctors’/Medical practitioner’s fees

Post-hospitalization expenses are similar in nature, and sometimes referred to as
‘recuperation expenses’. Meaning the medical expenses incurred by the insured to regain
his/her pre-illness/injury condition.

Both pre and post-hospitalization expenses will be covered, only if the following
conditions are met:

 The insurer has accepted the claim for hospitalization expenses

 The expenses have been incurred for the same illness/injury/disease for which
the hospitalization was required.

 The expenses have been incurred within the time limits prescribed by the insurer:
o Pre-hospitalization time limit ranges between 30 to 60 days before
hospitalization
o Post-hospitalization time limit ranges between 60 to 90 days after
hospitalization

 The Hospitalization was inpatient treatment and not domiciliary hospitalization

When They are Covered

Karan Dumra had been feeling ill for a while before he had to request sick leave. He had
been suffering for three days with intermittent fever, which he thought was a simple viral
and could be suppressed with generic antibiotics.

On the fourth day, he experienced shivering and very high fever, which was simply not
normal viral case anyone in his family had seen before. So, they decided to go to a
doctor for consultation. Since it was quite difficult for Karan to move out, the doctor was
called home, and after preliminary checks, he advised blood tests and ultrasound for
liver, etc.

DISEASE SUBLIMITS

Importance of a sub-limit in a health insurance policy

A sub-limit is one of the critical features to evaluate in health insurance. They are
usually expressed as a fixed value for a particular illness/disease or treatment but can
also be included as percentage of the total sum insured. Many health insurance
providers place two kinds of sub-limits on the insured – on the hospital room rent and
the sum assured for specific diseases. Some companies also provide the insured the
option to opt for or opt out of sub-limits. Depending on your budget, you can opt for
either of the two but remember that an insurance plan with no sub -limits has a higher
premium. Also, check if charges such as room rent and medical costs are within the
reimbursable limit before getting treated in any hospital.

Let’s understand the two key sub-limits so that policy buying is better and easier for
you:

1. Sub-limit on room rent

Under the room rent sub-limit option, your insurance company covers the room rent
per day but only up to a certain limit. The type of the room is also capped. For
instance, the insurer includes only the general room or semi -private room in its
insurance plans. If you need a private room then you may have to pay extra for it from
your pocket. If your room rent cap in your insurance plan is Rs 4000 per day and you
opt for a room that costs Rs 6000 per day, you will have to pay the difference of Rs
2000 from your pocket

Also, hospital charges are linked with the type of room you opt for. Most of the
medical expenses such as surgical procedures, doctor’s consultation charges or
operation theatre fee may vary depending on the type of room you are staying in. A
twin-sharing room or a general room may cost less as compared to a private room.
However, it is advisable that you discuss this sub-limit clause with your insurance
provider to avoid any last-minute confusion during your hospitalization or while filing a
claim.

Read- Top Health Insurance Companies

2. Sub limit on specific treatment
Before you decide to buy a policy with a sub limit on specific treatment, you must
check the list of diseases/ailments which come under the sub limits clause and the
costs specified against each of them. Even though your sum insured is high, but you
may not be claiming your entire hospitalization expenses due to the sublimit clause on
specific medical procedures. For instance, if there is a sub limit clause of 50% of sum
assured for cancer treatment, then even if your total sum assured is Rs 10 lakh, you
cannot claim more than Rs 5 lakh due to the sub limit clause.

Therefore, if you want to make sure that your hospitalization and claim procedure to
be hassle-free , it is important that you go through the sub-limit clauses and choose
only those policies, which does not contain certain discomfiting clauses and yet meet
your budget and needs.

ROOM RENT & ICU

The litmus test of any insurance policy occurs at the time when a claim arises.
According to recently published industry data, the number of customer
complaints against health insurers has gone up primarily on account of
dissatisfaction with claim settlement. The main reason for this relates to sub-
limit of room rent - a common feature in health insurance policies. Let's look at
the importance of this sub-limit feature, why it remains a problem in claim
settlement and how to overcome it.