Is Day Care Treatment Covered in Health Insurance?

Udaipur, Aug 28, 2025: As technology in the healthcare sector advances, many treatments that once required days of hospitalisation can now be completed within a few hours. This shift has given rise to day care treatment.

For health insurance policyholders, this raises an important question: are such procedures covered under their plans? Understanding the scope of day care coverage in health insurance policies can help you make the most of their benefits while avoiding unexpected expenses.

In this article, we will take you through the ins and outs of day care coverage in modern health insurance plans and everything else you should be aware of.

What are Day Care Procedures?

Day care procedures refer to medical treatments or surgeries that require hospital admission but do not extend beyond 24 hours. These are typically carried out using advanced medical techniques that allow faster recovery and minimal hospitalisation.

Unlike outpatient consultations, day care treatments involve clinical intervention under anaesthesia or in a specialised hospital setting. Examples of day care procedures include cataract surgery, dialysis, chemotherapy, hernia repair, radiotherapy and sinus surgeries.

These procedures differ from routine OPD (outpatient department) visits as they require admission, even if brief. Most insurance companies provide a detailed list of treatments classified as day care, which is crucial to review when selecting or renewing a policy.

Does Health Insurance Cover Day Care Treatment?

Most modern health insurance policies in India do cover day care procedures, recognising the shift in medical practices that allow treatments to be completed within 24 hours. Earlier, health insurance policies offered coverage only for hospitalisations exceeding 24 hours.

However, with advancements in medical technology and changing healthcare needs, insurers have revised their offerings to include a wide range of day care treatments. The number of covered treatments can vary significantly from one insurer to another.

By covering day care procedures, health insurance ensures that policyholders are financially protected even for shorter hospital visits involving necessary medical care.

How Does Day Care Health Insurance Work?

Day care health insurance works similarly to regular hospitalisation coverage but is specifically designed to cover medical procedures that require less than 24 hours of hospital stay. The process of availing coverage typically involves the following steps:

• Hospitalisation for a Covered Procedure: The insured undergoes a medical treatment that is listed as a covered day care procedure under the policy. Though the stay is short, it must occur in a registered hospital or medical facility.
• Cashless or Reimbursement Claim: If the hospital is part of the insurer’s network, the insured can avail of cashless treatment by notifying the insurance provider in advance or at the time of admission. For non-network hospitals, the insured pays the bill upfront and files for reimbursement later.
• Documentation and Claim Settlement: Necessary documents, such as hospital bills, discharge summaries, medical reports, and doctor's prescriptions, are submitted along with the claim form. The insurer verifies the claim and settles the amount according to the policy terms.

In essence, day care health insurance makes it easier for policyholders to access and afford short-duration treatments without being denied claims for not meeting the 24-hour hospitalisation rule.

Common Day Care Procedures Covered Under Health Insurance

Health insurance providers offer coverage for a wide range of day care procedures that do not require prolonged hospitalisation. While the exact list varies by insurer, some of the most commonly covered treatments include:

• Cataract Surgery
• Tonsillectomy
• Chemotherapy and radiotherapy
• Dialysis
• Lithotripsy
• Sinus surgeries
• Hernia repair
• Angiography
• Ear, nose and throat surgeries
• Minor orthopaedic surgeries
• Coronary Angiography
• Tongue surgeries
• Colonoscopy
• Appendicectomy

Insurers may cover over 100 to 500 such procedures depending on the comprehensiveness of the plan. Always refer to the policy brochure or consult with the insurance provider to confirm which specific treatments are included.

Conditions for Day Care Coverage

To be eligible for insurance benefits for daycare procedures, policyholders must meet the conditions outlined by the insurer. These conditions ensure that the claim is valid and aligns with the policy terms. Common conditions include:

• Listed Procedures Only: Coverage is limited to specific procedures mentioned in the policy document. Not all short-duration treatments may be included.
• Hospital/Facility Requirements: The procedure must be performed at a registered hospital or an approved day care center that meets the insurer’s infrastructure and licensing criteria.
• Doctor's Recommendation: The procedure should be medically necessary and recommended by a certified doctor. Cosmetic or elective procedures are generally excluded.
• No 24-Hour Hospitalisation Needed: Day care procedures are defined by the fact that they do not require a full 24-hour stay. However, some policies may require at least a few hours of admission.
• Waiting Period May Apply: Some day care treatments may not be covered immediately after purchasing a policy. The waiting period in health insurance refers to the initial duration during which certain claims are not admissible.
• Pre-Authorisation in Some Cases: For cashless claims, insurers may require pre-authorisation for planned day care procedures.
• Policy Must Be Active: The health insurance policy must be valid and premiums should be up to date at the time of treatment.

What Is Not Covered Under Day Care Treatment?

While day care coverage in health insurance offers protection for a wide range of short-term medical procedures, there are certain exclusions that policyholders should be aware of. These may include:

• OPD Consultations: Routine doctor visits and outpatient consultations that do not involve surgery or hospitalisation are generally not covered.
• Diagnostic and Preventive Procedures: Standalone diagnostic tests like X-rays, MRIs or blood tests, even if done in a hospital setting, are not covered unless they are part of a day care treatment.
• Cosmetic or Aesthetic Procedures: Surgeries done for cosmetic reasons, such as plastic surgery or Botox treatments, are usually excluded unless medically necessary due to an accident or deformity.
• Fertility Treatments: Procedures related to infertility, including IVF and IUI, are commonly excluded from day care coverage.
• Experimental Treatments: Any treatment or procedure that is not recognised or approved by the relevant medical authorities may not be covered.
• Unlisted Procedures: Only treatments specifically listed in the policy’s day care procedure list are eligible for claims. If the procedure is not mentioned, coverage may not apply.

How to Choose a Day Care Health Insurance Plan?

Selecting the right health insurance plan with comprehensive day care coverage can significantly impact your healthcare experience. Consider the following factors to make an informed choice:

• Check the List of Covered Procedures: Review the insurer’s list of day care procedures. Opt for a plan that covers a broad range, ideally over 100 treatments, to ensure you are protected across various medical scenarios.
• Verify Network Hospitals: Ensure the insurer has a strong network of hospitals that provide cashless day care treatment. A wider hospital network increases convenience and accessibility.
• Evaluate Claim Settlement Ratio: A higher claim settlement ratio reflects the insurer’s reliability and increases the chances of hassle-free claims for day care treatments.
• Assess Waiting Period in Health Insurance: Understand the waiting period for pre-existing conditions and specific treatments. Shorter waiting periods mean quicker access to day care benefits when needed.
• Look for No Sub-Limits: Some insurers impose sub-limits on specific procedures. Choose plans that don’t cap day care claims under predefined limits to avoid unexpected out-of-pocket expenses.
• Compare Premiums and Features: Balance cost with benefits. The cheapest plan may not offer adequate day care coverage. Compare multiple plans to find one with the right mix of affordability and protection.
• Read Policy Inclusions and Exclusions Carefully: Know exactly what is and isn’t covered to avoid claim rejections, especially for day care treatments that might fall into grey areas.

Health insurance policies that include day care coverage offer broader protection, ensuring that even short-duration treatments don’t lead to financial strain. From cataract surgeries to dialysis, these procedures are now commonly covered, provided certain conditions are met.

To fully benefit from this feature, it's essential to choose a health plan that offers comprehensive daycare coverage, has a broad network of hospitals, and aligns with your medical needs and lifestyle.

#HealthInsuranceIndia #DayCareCoverage #ShortHospitalStay #MedicalInsuranceTips #CashlessHealthCare #CataractSurgeryInsurance #DialysisCoverage #UdaipurTimes