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You must have encountered the terms inpatient and outpatient when discussing health insurance plans. Both inpatient and outpatient refer to the medical services offered in a hospital. The difference primarily lies in the type of treatment offered under inpatient and outpatient. The duration an insured receives medical treatment at the hospital also defines the difference between inpatient and outpatient care.
To have the edge while seeking a medical service, it is crucial for you, as a policyholder, to understand the differences between outpatient and inpatient. You can plan your expenses accordingly when you know the details of your plan and its various coverages. This article will focus on the distinctions between inpatient and outpatient health insurance. Let's begin.
What Constitutes Inpatient Hospitalisation?
Before moving on to inpatient vs outpatient care, here is a quick description of inpatient hospitalisation cover. Inpatient treatment is when a patient requires hospitalisation for over 24 hours. Serious health problems and major surgeries usually require extended hospital care, and such therapies fall under the category of inpatient treatment. Any medical treatment that does not exceed 24 hours of hospitalisation is not categorised under inpatient treatment.
To better understand inpatient hospitalisation, here is a list of common treatments that usually require hospitalisation of over 24 hours and, thus, fall under inpatient treatment:
- Traumatic injuries
- Major heart surgeries
- Severe burns
- Cancer treatment
- Organ transplant
- Reconstructive surgeries
- Plastic surgeries
- COPD (Chronic Obstructive Pulmonary Disease) treatments
- Long-term mental health treatment.
What is Outpatient Hospitalisation?
To fully understand inpatient vs outpatient services, let's focus on the meaning of outpatient treatment. Outpatient medical services are treatments that do not require hospitalisation for more than one day or 24 hours. Unlike inpatient treatment, which can be lengthy, outpatient services are short-term and are done within a few hours.
Since the patient doesn't need hospitalisation for long hours, it is usually performed in the outpatient department. You may have come across the term OPD (Out-Patient Department) in a hospital. This department usually deals in outpatient services and treatment.
Common outpatient treatments may include:
- Screenings like colonoscopy, mammogram, endoscopy, etc.
- Laparoscopic surgeries
- Minor surgeries like LASIK eye surgery, mole removal, laser treatment, etc.
- Dialysis
- Chemotherapy
- Root canal
- Gum grafting
- Other dental surgeries.
Inpatient Vs Outpatient Hospitalisation
Now that you know about inpatient and outpatient care, let's understand what's the difference between outpatient and inpatient treatment. The table below explains in detail health insurance inpatient vs outpatient:
| Inpatient Treatment | Outpatient Treatment |
|---|---|
| Inpatient hospitalisation services involve treatment and surgeries that require hospitalisation for more than 24 hours | Outpatient hospitalisation refers to any medical treatment that does not require hospitalisation for more than 24 hours, including minor surgeries. |
| The coverage for inpatient treatment in health insurance can be comprehensive and is usually a part of the standard health insurance feature | Outpatient treatments may be covered under additional coverages of a health insurance plan or as the base cover |
| Major surgeries are usually covered under inpatient treatment | Minor surgeries, especially laparoscopic surgeries, are usually a part of outpatient treatment |
| Coverages involve room rent, ambulance charges, ICU cover, etc. | Lab tests, imaging expenses, consultation fees, diagnosis expenses, etc., are covered under the outpatient cover |
| The overall medical bill of inpatient expenses are high | In comparison to inpatient hospitalisation, outpatient treatment may be lower |
| Care Health Insurance covers inpatient hospitalisation expenses | With Care Health Insurance, outpatient treatments are usually covered under health insurance add-ons in specific health plans |
The table above will help you broaden your understanding of what's the difference between inpatient and outpatient treatment. While inpatient treatment focuses on long-term and complex medical care, outpatient treatments include short-term and minor medical services.
The Need to Invest in a Comprehensive Health Plan
Once you have a detailed idea of outpatient and inpatient differences, you may wonder if you should include both these features in your health plan! Considering the uncertainties of life and the shooting medical expenses with such a high medical inflation rate of 14% per year, it may be best to have a comprehensive health plan.
Although OPD expenses in a hospital are low compared to inpatient expenses, they can still cost you significantly. Treatments like chemotherapy and laparoscopic surgeries may not require hospitalisation, but can cost heavily on your pockets. Hence, having a comprehensive health plan that covers both inpatient and outpatient can be a great decision!
>> Also Read: What is Domiciliary Hospitalisation?
Does Care Health Insurance Cover Outpatient Treatments?
Yes. Care Health Insurance understands the changing dynamics of healthcare and the needs of its people. In today's time, comprehensive health insurance with a wide range of coverage can be your saviour in times of need. Care health insurance plans cover a range of outpatient treatments under OPD coverage. Depending on the chosen plan, you may get it as the base feature or as an optional cover.
Some of the popular Care Health Insurance plans that offer OPD covers are:
1. Care Classic Health Insurance
Check out the OPD features of Care Classic Health Insurance:
- Sub-limit up to ₹10,000
- Covers doctor's consultations and prescribed diagnostics
2. Care Advantage Health Insurance
Given below are some of the features of OPD cover in Care Advantage Health Insurance:
- Covers as many as 14 specialist consultations under OPD cover
- Insured can seek multiple consultation charges under OPD cover
- Each insured is eligible for 4 Physical Consultations from a General Physician in a Year. Maximum Rs.500/- will be reimbursed per consultation
3. Care Supreme Health Insurance
Here are some of the features of the OPD covered under Care Supreme Health Insurance:
- The insured can seek consultation from 14 specialities
- Under the OPD cover of Care Supreme, the insured can raise a claim for multiple consultation charges in a year.
These plans offer a high sum insured, a range of additional covers, and the benefit of OPD cover. The policy documents provide a detailed description of the OPD covers in these plans.
To Sum Up
Purchasing a health insurance policy is essential. However, having comprehensive knowledge of your purchased policy is equally vital for making an informed decision. It not only helps you skip unnecessary chaos and misunderstandings in times of medical need but also avoids claim rejections. Now that you know the basic inpatient-outpatient difference, you can quickly determine your expected hospital stay time and raise a claim accordingly.
Some health insurance plans may cover either inpatient or outpatient, while a comprehensive health plan may cover both of these hospitalisations. So, you must pick a plan that fits your requirements. Care Health Insurance allows you to choose a plan that best suits your needs. Purchase your ideal plan today!
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.
