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Group Health Insurance

What Are Day Care Treatment Procedures Covered Under A Group Health Plan?

By April 14, 2022No Comments

Group healthcare insurance policies provide monetary coverage for medical emergencies. It is a service benefit as the employer buys the insurance and pays the annual premium. The employees are the insurance holders, and the group healthcare plan may or may not cover the medical expenses for the employee’s family members. The employer of the organization determines which plan to choose based on the company’s affordability.

With group healthcare plans, the insurance holders can get coverage for hospitalization expenditure and daycare treatment. While most people are aware of the types of hospitalization treatments, daycare medical procedures are still a blurry concept. 

Day care procedure – How is it different?

Daycare treatments are those treatments and procedures that do not need hospitalization for more than 24-hours. In the past a surgery or medical procedure required a prolonged stay in hospital but with the advancements of technology in the medical field, some procedures or surgeries can now be completed in less than 24 hours. Thus, while the patient is in hospital for a short period of time, they do not spend 24 hours in the hospital, which is the minimum period for which claims can be filed under normal definition of health insurance. Medical Expenses for a day care procedure need to be taken in a Hospital or standalone day care center but not the out-patient department of a Hospital or standalone day care center.

Some of the most popular examples of daycare treatments include cataract surgeries, nasal sinus aspiration, cancer chemotherapy, radiotherapy, etc.  But doctor consultations and outdoor treatments are not part of the daycare treatment types. 

Not all short-term medical treatment at a hospital or outdoor emergency unit is day care treatment. These are OPD or outpatient department treatments where a doctor supervises a health checkup. It does not involve any significant surgery, and the patient does not need to get hospitalized. Any clinical treatment procedure can be an OPD treatment. A perfect example would be a root canal at the dentist’s clinic. It may be a surgical process, but it does not need hospitalization. Thus, such treatments are out of the daycare category. 

In contrast, a day care treatment is a surgical process with full-body or local anesthesia. The new-age medical equipment and surgical procedure help complete the treatment within a day. 

Examples of daycare treatment – These are the daycare treatment examples that qualify for group health insurance coverage 

 

OperationsProcedures/Inclusion
EyesCataract operation.Removal of foreign body.Corneal incision.Tear duct operations.Eyelid incision.
Nose and SinusNasal sinus aspiration.Operation on nasal concha.Other operations on the nose.Foreign body removal.
EarStapedotomy.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.
TongueReconstruction of the tongue.Glossectomy.Other operations on the tongue.
BonesLigament tear and meniscus tear surgery.Orthopaedics and trauma surgery.Fractures and sutures on tendons.Dislocation surgery.Other joint and bone surgery.
Skin and subcutaneous tissueSkin transplantation and restoration.Chemosurgery to skin.Incisions to skin and subcutaneous tissue.Excision of diseased skin and subcutaneous tissues.
FacePlastic surgery to the mouth.Incisions to the mouth, jaw and face.Other operations to the mouth and face.
Other operationsLithotripsy.Coronary angiographyHaemodialysis.Radiotherapy (for cancer).Chemotherapy.
Day care treatment Operations and Procedures

Daycare treatment and insurance coverage

Not all insurance companies offer you equal coverage and medical benefits. In fact, with some group health insurance daycare coverage is a default coverage and all policies provide them as a value add along with hospitalization, pre and post hospitalization coverages.

Most insurance companies cover the daycare treatment procedures mentioned above. With the insurance coverage, the insured person can get financial support for expenditures, like – Room charges, nursing expenses, surgeon fees, operation expenses, prosthetic devices, orthopedic implants, and surgical appliances. Medicine expenses, etc. 

The inclusions and exclusions in the coverage package for daycare medical expenses can vary with the insurance provider you have chosen. Thus, you must check the coverage regulations and protocols to clarify your doubts. 

Is it advantageous for you?

Having the daycare treatment coverage option in the group healthcare policy is advantageous for you in more than one way. Get optimal coverage for hospitalization costs and obtain peace of mind during medical emergencies. Also, the claiming process is hassle-free. You can also avail of a cashless treatment facility with daycare treatment coverage. Another beneficial aspect of having insurance coverage is you get consistent claim support from repetitive medical procedures. For chemotherapy or hemodialysis, the patient has to undergo treatment frequently. With the coverage option in the healthcare policy, one can get monetary support from the insurance provider to meet the costly treatment expenditure.

Exclusions to note in the coverage regulations

Minor injuries that could get medically treated at a clinic do not qualify for coverage. Even if you get hospitalized for treating the symptoms or for an illness diagnosis, the insurer will not settle the daycare coverage claim. Your claim will get rejected, and you cannot obtain a cashless facility in such situations. Thus, check if it qualifies for daycare expense coverage while undergoing treatment. Otherwise, the insurer counts it under OPD care and does not offer full support. Cosmetic surgeries are also not under daycare coverage, but you can extend the coverage benefits by buying the bonus coverage packages (add-on) with an extra charge.

Does your insurance cover them all?

Group healthcare insurance plans cover daycare expenses, but there can be variations depending on the insurance company. You have to check the coverage rules and determine the inclusions and exclusions. The technical terms can be tricky and difficult to understand unless you are up to date with the insurance technicalities. In such cases, connecting to an insurance broker or expert is the best option. You can find credible information from the insurance experts from PlanCover, the leading insurance broker for all small to large businesses. 

Compare and evaluate to understand

With PlanCover, get an overall idea about the inclusions and exclusions of daycare expense coverage of all the leading IRDA-approved insurance companies. Get authentic information and a comparison report based on the pros and cons of each insurance policy. The executives from PlanCover can help you find the best group health insurance for your employees and organization, depending on the specific requirements. 

PlanCover – Assisting you with quality advice.

Connect to PlanCover to find quality guidance and dedicated assistance in every step. From advising you on the best insurance practices to bringing you the most beneficial group healthcare plan, PlanCover covers it all! Get end-to-end service assistance from the proficient team at the most competitive package with PlanCover. 

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