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Complete Guide to Daycare Procedure in a Group Health Insurance Policy

Nov 1, 2023


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Group Health Insurance Policy

Complete Guide to Daycare Procedure in a Group Health Insurance Policy

Daycare Procedure in a Group Health Insurance Policy – Definition

A Daycare Procedure/Treatment in a Group Medical Insurance Policy is usually defined as “any medical treatment, and/or surgical procedure which is:

  1. undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technological advancement, and
  2. which would have otherwise required hospitalization of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the scope of this definition”

Essentially, a Day Care Procedure is any treatment, medical operation or surgery that requires hospitalisation for less than 24 hours owing to medical advancements. Daycare Procedure Coverage is an important feature of a Group Health Insurance Policy. It is important for the employers to understand the concept of Daycare Procedures in a Group Health Insurance Policy.

Are Daycare Procedures covered in a Group Health Insurance Policy?

Yes, Daycare Procedures are covered in a Group Health Insurance Policy. Today, with advancements in medical technologies, a lot of procedures such as Chemotherapy, Cataract Operation, Dialysis takes less than 24 hours.

A Group Health Insurance Policy, which pays for hospitalisation expenses only if the hospitalisation period exceeds 24 hours would not cover such procedures. As a result, there was a need to cover Daycare Procedures under a Group Mediclaim Insurance Policy. Today, most GMC Polices provide cover for Daycare Procedures.

However, it should be noted that Outpatient Department (OPD treatments) are not considered as Day Care Treatments and a Group Health Insurance Policy does not provide cover for OPD Treatments unless coverage for OPD Treatments is specifically opted in the Group Mediclaim Insurance Policy for employees.

OPD treatments are defined as treatments in which the Insured visits a clinic / hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of a Medical Practitioner. The Insured is not admitted as a day care or in-patient.

What is the difference between Day Care Procedure and OPD Treatments?

The major difference between Day Care Procedures and OPD Treatments is that OPD Treatments refers to routine Doctor Consultations or minor treatments like Stitches or Fractures. OPD Treatments do not require hospitalisation. On the other hand, Day Care Treatments/Procedures require that the Treatment is availed at an Hospital. However, the Hospitalisation time period for Day Care Treatments/Procedures is less than 24 hours.

What are the Examples of Daycare Procedure in a Group Health Insurance Policy?

Few examples of Daycare Procedures are cataract eye procedures, chemotherapy, Dialysis and radiotherapy. A list of other common Daycare Procedures usually included under a Group Health Insurance Policy are:

Treatment Operations/ Procedures
Eyes Cataract, eyelid incision, corrective surgery for entropion
Nose Nasal sinus aspiration, operations on nose, foreign body removal
Ear Stapedotomy, tympanoplasty, incision of inner ear
Tongue Reconstruction of tongue, glossectomy
Face Plastic surgery to mouth
Other Coronary angiography, radiotherapy, chemotherapy

The above list is only a representative list of Daycare procedures and is not an exhaustive list. The list of complete daycare procedures can be availed from your Group Health Insurance Broker or Group Health Insurance Company. The employer should always check the list of Daycare Procedures before finalising the Group Mediclaim Policy for Employees.

Compare Group Health Insurance Plans with Qian!

This article explained the concept of Daycare Procedures in a Group Health Insurance Policy. Daycare Procedures is an important feature of a Group Health Insurance Policy and should not be overlooked.

Qian is an experienced Group Health Insurance Broker in India with tie-ups with 20+ Group Health Insurance Companies in India. You can compare Group Health Insurance Plans with multiple Group Health Insurance Companies with Qian and select the plan best suited to your needs.

If you wish to purchase a Group Health Insurance Policy, email us at 📧 support@qian.co.in or call us on 📞 022-35134695. We would be glad to assist you.

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