As a child, we were always taught about the virtues of saving time as life is all about being fast and efficient. Medicine and health care are no example to it. All the research and advancement focus on making the health care fast and accurate. In Earlier times, the medical treatments were used to be prolonged and time consuming.
Day Care Hospitalization
Recent advancement has reduced the time for the treatments but has increased the cost too as machines are replacing men. Health insurance doesn’t accept small duration hospitalizations. However health policies have a ‘Day Care Hospitalization’ procedure.
Julien, a subscriber of a health insurance plan discovered the he has a kidney stone. He contacted a hospital and found out that he has to undergo a lithotripsy surgery. Hospital will discharge him in 2 hours but the cost of treatment is 50,000 INR. Julien is worried as he read the policy documents and hospitalization of more than 24 hours is only considered to be payable.
Health insurance lacks the cover for small and over-the-counter medical expenses as they might not justifiable which makes it difficult to process short term genuine claims. Day Care procedures are encouraged by IRDA to cover some specific treatments. ‘Day Care’ means treatment procedures that require hospitalization for less than 24-hours hospitalization.
Expenses on hospitalization are admissible for a minimum period of 24. However, this time limit is not applicable to specific treatments such as:
- Coronary angioplasty
- Dental surgery
- Eye surgery
- Lithotripsy(kidney stone removal)
Except from approved treatments falling under Day Care, all other treatments require a minimum hospitalization of 24 hours for insurance company to admit its claim. Thus Julien should feel happy that his treatment is included in the eligible treatments and will get reimbursed.
Not only is this clause beneficial but flexible too. Transfer from one hospital to another hospital is also allowed but it has to be proved that such transfer was purely for the health benefit. Except from the scope of coverage, the day care Hospitalization is similar to regular indemnity based health plans, where hospitalization expenses are reimbursed by the company either through cashless route or after submission of required documents.
Day care facility is included in many health insurance policies but one can have it as outpatient department (OPD) health policy. However, there is a difference between ‘day care’ and OPD policies. Day care includes short term treatments while OPD covers the treatments which are expensive and generally covers ‘day care’, dental and maternity expenses.
A last piece of advice is that while opting for a day care policy, don’t focus on the number of covers but the definition of the covers as a single cover, say eye surgery, itself includes 8-9 covers.
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