Day Care Treatment In Group Health Insurance

Daycare treatment is a policy in health insurance that covers all the expenses of the policyholder when they undergo treatments that do not require more than 24 hours. The Insurance Regulatory and Development Authority of India (IRDAI) has instructed health insurance companies to include a list of daycare treatments under their insurance policies. The treatment expenses will be borne by the insurer either through reimbursement or a cashless facility.

Let us dig deeper into day care treatment and the scope of coverage in employee insurance policy.

Day care treatment list

Different health insurance companies have a different extensive list that includes all the treatments covered in daycare treatment. Therefore, the policyholder must thoroughly go through the policy document carefully to avoid any future hassles. Some of the general treatments include:

• Ear, Nose Throat (ENT): Foreign body removal, Septoplasty, Nasal Sinus treatment, Tonsillectomy, Tympanoplasty.
• Heart-related treatments like coronary angiography.
• Cancer treatment like radiotherapy, chemotherapy.
• Eye treatment like removal of foreign body, cataract surgery, tear duct operations.
• Tongue incisions, excisions, glossectomy.
• Hemodialysis, colonoscopy, Appendix, hemorrhoids, skin treatments, and dental treatments.

Advantages of day care treatment

Due to the high inflation rate in the health care industry, the cost of surgeries and treatments is at an all-time high. Therefore, having this policy has the biggest advantage of saving a lot of money.

Policyholders can avail of cashless facilities by getting their treatment done in any one of the network hospitals of insurers. Alternatively, they can avail of reimbursement from insurers if they take the treatment from a hospital not under their network or PPN.

Read: Network vs non-network hospitals

It is easy to claim this treatment for policyholders as it usually follows the same procedure that of in-patient hospitalization. The insurers pay the total sum of the treatment.

This provides continence to policyholders as they need not worry much about bills, and can access quality medical care without any problems. The policyholders can recover their health with peace of mind.

Daycare treatment also provides tax benefits to the policyholders according to Section D of the Income Tax Act, 1961.

Day care treatment in group health insurance

Usually, day care treatment is not covered by default in group health insurance policy for employees. The day care treatment can be covered by adding a rider to the existing group health insurance plan.

However, some insurance companies like Aditya Birla Group Health Insurance Company have a group plan called Group Activ Health, which covers the day care treatment. Around 527 day care treatment procedures are covered in that plan.

So, by adding a day care treatment add-on to the group mediclaim policy the employers can provide maximum advantage to the employees. In this way, treatments that require 24 hour hospitalisation like ENT, Angioplasty can be covered using this rider.