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SMC Insurance Brokers Pvt. Ltd.
Parsvnath Metro Mall, Near Pratap Nagar Metro Station, Pratap Nagar, New Delhi-110007
Registration No: 289, Registration Code No: IRDAI/DB-272/04/289, Valid till: 27/01/2026, License category: Direct Broker (Life & General), CIN: U66000DL1995PTC172311
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Are Day Care Procedures Covered By Health Insurance?
Over the past few decades, medical science has advanced tremendously. Today, doctors can cure illnesses that once required days of hospitalisation in just a few hours. Health insurance plans in India have also changed their scope of coverage in response to these changes.
Imagine you are advised to undergo a colonoscopy in order to check the health of your colon. According to the doctor, the entire procedure shall take an hour or two and further adds that you can return home right away. However, you are unsure whether your health insurance would cover the procedure or not. Meanwhile, when you reach out to the hospital's insurance desk, you learn that your policy covers Day Care procedures as well.
It is evident that health insurance policies cover day care procedures as well. This article explains Day Care Treatment Coverage under Health Insurance in detail.
What Is A Day Care Procedure?
A day care treatment is one that is performed under general or local anaesthesia in a hospital or a day care centre, and takes less than 24 hours to complete. Insurers will cover day care procedures only if they are prescribed in writing by a doctor and deemed medically essential.
Day Care treatment usually includes the following procedures:
- Piles / Fistula
- Angiography
- Dialysis
- Cataract
- Chemotherapy
- Colonoscopy
- Sinusitis
- Eye surgery
- Hydrocele
- Appendectomy
- Lithotripsy
- Liver aspiration
- Prostate
- Radiotherapy
- Sclerotherapy
This is just a partial list of some of the most common procedures. The actual list is much longer. Moreover, the types of treatments covered depend on the policy you choose.
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Do You Need To Compare The Number Of Day Care Procedures?
Most health insurance companies mention the number of day care treatments they cover in their policy documents. Avoid looking at figures alone, as they can be deceiving.
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What's the Reason?
As you read through the list, you may notice that some insurers describe a procedure for a specific organ in a general sense, whereas others describe diseases and treatments in more detail.
For instance, "Bone surgeries" is a broader category in some insurance policies. However, another insurer may segment this further into Ligament & Meniscus Tear Surgery, Orthopaedics and Trauma Surgery, Fracture and sutures on tendons, Dislocation Surgery, etc. It is likely that a detailed list will result in a greater number of treatments being included, but because of the level of detail, specific ailments may be overlooked.
Comparing Day Care Procedures Between Different Policies: How To Do It?
The process of reading through procedures and comparing them to another insurance company’s list is very difficult unless you are well versed in medical terminologies.
Plus, many leading insurers now offer plans without a list of day care procedures.They essentially say that all kinds of necessary hospitalizations will be covered without any limitations.
According to our analysis, this is the most effective choice when it comes to Day Care coverage. Choose a company that covers All Day Care Procedures rather than a narrowly defined list - so you are covered always, come what may.
Day Care Procedures V/S OPD
| Factors | Day Care Treatment | OPD Treatment |
|---|---|---|
| Definition | You undergo surgery in an operation theatre under anaesthesia while being admitted in a hospital. | The day-to-day medical consultations or small treatments such as dressing a wound or stitching a minor wound carried out under local anaesthesia. |
| Hospitalisation | Hospitalisation spans less than 24 hours. | Hospitalisation is not required. |
| Examples | Cataract surgery, angiography, chemotherapy, etc. | Health checkups, minor injuries, etc. |
Claims Process For Day Care Procedures
The Day Care claims process is similar to regular health insurance claims since day care procedure coverage is part of the policy. You can make use of either reimbursement or cashless claims.
In order to be eligible for a cashless claim, you need to get treated in the network hospitals of the insurance company.
If you opt for a reimbursement claim, you can get treated in a hospital of your choice and pay all the medical expenses upfront. You can show the bills and all the necessary documents to the insurer - to get reimbursement.
Any pre-hospitalization and post-hospitalization expenses that you may incur are also covered by your health insurance plan. The T&Cs regarding coverage remain the same.
Pre-hospitalization Expenses - Costs related to tests or consultations before undergoing treatment or getting admitted to the hospital such as CT scan cost, blood test cost etc.
Post-hospitalization Expenses - Expenses that you incur after you are discharged from the hospital such as follow-up costs, diagnostic tests costs, physiotherapy costs etc.
Expenses such as doctor's fees, dental treatment, tests, and medical bills are also covered by some insurers. There are exceptions to this
Depending on the policy document, these expenses may also be subject to sub-limits. As coverage may vary from policy to policy, it is important to read the policy document carefully.
Summing Up!
Health insurance policies not only cover major surgeries, treatments and hospital stays, but also day care procedures. If you are looking for ideal day care coverage, you should go for policies that cover a broad range of conditions rather than those that list specific procedures.
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Our Customers' Stories
Sharing the experience of happy and satisfied customers with you.
Sameer Yadav
I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More
Dheeraj Bhatia
I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More
Jyoti Sharma
We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More
Sumit Khanna
Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More
Kishor Kumar Bijlani
My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More
Megha Singhal
I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More
