Skyrocketing medical expenses have made health insurance policies more popular and useful than ever before. More and more people are becoming aware of the financial cushion that a health insurance plan offers in times of medical needs. There are different types of health insurance plans covering the varied needs of the customers. The need for hospitalisation does not occur in all the cases yet other medical expenses can sum up to be a huge expense overall. Such medical services include daycare in hospitals and OPD treatments. These are the medical needs where even if hospitalisation does not exceed 24 hours, expenses can be hefty. Let's get into details of what is OPD and what constitutes daycare.
OPD stands for Out-Patient Department, which refers to the patients who have come for consultation or diagnosis purposes. Such patients are not hospitalised. Around 62% of patients in India need OPD treatment rather than hospitalisation. Sometimes, these OPD treatment expenses can affect savings and the monthly budget of people, which is why many people even refrain from OPD visits. In such times, if you have a health care plan with OPD cover, you need not worry about the escalating OPD expenses. For example with Care Health Insurance OPD add-on cover, you can be assured of 4 general physical consultations and any 4 specialist consultations out of 14 specified specialists up to Rs 500 for each consultation.
The outpatient department covers various healthcare facilities. The OPD treatment list is as follows:
For various health illnesses and diseases, the patient has to undergo certain diagnostic tests. These tests and diagnosis procedures can be costly. Hence, the OPD cover includes diagnostic tests.
Consulting a good doctor is what everyone wants. However, due to hefty fees and repetitive consultation, people often avoid it and compromise their health. With the OPD cover of Care Health Insurance, you no longer have to ignore the doctor's consultation of your choice.
Doctors may perform investigative tests like blood tests before diagnostic tests. Expenses of such tests are also covered under OPD care.
Upon consultation and diagnosis, doctors may prescribe required medicines. Pharmacy expenses are also covered by your health insurance provider under OPD coverage.
Daycare treatment refers to any medical surgery and treatment procedure that does not require hospitalisation of over 24 hours. Common examples are laparoscopic surgeries, cataract surgery, etc. These treatments are usually completed within a few hours and the patient is also released within a few hours post-surgery.
Daycare treatment does not exceed 24-hour hospitalisation so, in-patient hospitalisation cover does not imply here. Health insurance plans offered by Care Health Insurance cover day care services in hospitals from 540+ to all day care procedures depending on the plan types.
With the advancements in medical science, complex surgeries and treatments have been simplified to reduce both treatment and recovery time. Many of these treatments fall in the category of day care treatment disease list. Here is the daycare treatment list that is covered by Care Health Insurance:
Note: These are some of the 540+ day care treatments covered by Care Health Insurance. See your policy brochure for the complete list.
Now that you know what is OPD cases and day care treatments, let's understand the differences between daycare & OPD. The table below explains the major differences between the two:
| Particulars | Daycare | OPD |
|---|---|---|
| Coverage | Day care coverage is included in most health insurance policies. The coverage for under daycare treatments is up to the sum insured limit. | OPD is an optional cover. As an insured, you may or may not choose to have this cover. The coverage of OPD is up to a specific limit and not the entire sum insured. |
| Waiting Period | The waiting period for daycare treatments can be longer. In some cases, depending on the chosen surgery, the waiting period can be up to 3 years. | The waiting period for OPD cover is short. Within a few months, the insured can begin raising claims for the OPD cover. |
| Claim Settlement | Through cashless treatment facilities and reimbursement claims, the insured can raise a claim for daycare treatments. For cashless treatment, one has to avail of medical services from one of the 9747+ network hospitals of Care Health Insurance. | OPD cover can only be availed through reimbursement claims. This means that once you are done with the OPD services, you can submit bills to your insurance provider for reimbursement of the admissible expenses. |
| Hospitalisation | Daycare treatments do not exceed hospitalisation beyond 24 hours. | OPD services need no hospitalisation at all. |
| Who needs? | Daycare treatment coverage is usually offered under health insurance plans. Although daycare treatments do not need hospitalisation, expenses can be high. Surgeries that need hefty expenses are easy to deal with when you have daycare treatment covered. | OPD services are not as costly as daycare procedures. However, regular OPD services can become heavy on pockets. For people who need regular doctor's consultations like diabetes and thyroid patients, OPD coverage can be of great importance. |
A health insurance policy is the much-needed cover when it comes to high-cost healthcare treatments. Since some of the surgeries and medical services in daycare treatments and OPD have a waiting period, it is best to invest in a health plan as soon as you can. Not only does it help you pass the waiting period without any hassle, but you are also likely to pay a lower premium.
The chances for daycare treatments, like cataract surgeries, may increase with age. So, why not invest early so you can make the most out of it? Also, OPD services are needed by most people and hence, having this optional cover can further save your hard-earned savings. If you haven't invested in a health plan so far, Care Supreme is our premium plan that comes with exclusive offerings. Apart from this, we’re here with a range of options for you to choose from. Invest in your preferred health plan today!
>> Also Read: Benefits of Health Insurance with OPD Cover in India
Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
Published on 12 Dec 2024
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