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What is the Difference Between OPD and Daycare Treatments?

Outpatient department (OPD) treatment refers to a patient’s visit to the doctor’s clinic or hospital for routine checkups or medicines. Daycare treatments are medical procedures that require hospitalisation for less than 24 hours.

Health insurance is a necessity in the current scenario. It provides access to quality healthcare facilities and protects you from financial burdens during medical emergencies.
 

However, people often need clarification on the technical jargon written in their health insurance policies. For instance, outpatient department (OPD) treatment cover and daycare treatment cover are similar terms with different meanings, which can easily confuse a policyholder.
 

While deciphering the technical nuances of the policy wording can be time-consuming, you can have a claim rejected because of a mistake at your end in understanding the clauses. Here is a guide to help you differentiate between the coverage for OPD and daycare procedures.

What Is OPD Treatment?

The OPD full form in medical terms is Outpatient Department. The treatment takes care of frequent visits or medical checkups at a clinic. In this case, you do not need hospital admission. You can visit the doctor’s chamber, consultation room, diagnostic centre, pharmacy, etc.
 

Many health insurance plans provide an OPD cover. It includes coverage for doctor’s consultation fees, pathological test bills, examinations, etc. Some insurance policies also provide maternity, daycare, and dental treatment coverage.
 

For instance, it is OPD treatment if you visit the doctor complaining of a minor stomach ache, and the doctor performs a checkup to prescribe medicines.
 

It is advisable to go through the OPD treatment list in your health insurance policy to understand what is covered and what is not.

What Is Daycare Treatment?

An insurance company considers a medical or surgical procedure that requires less than 24 hours of hospitalisation as daycare treatment. It is beneficial to have a policy that offers daycare coverage. In this situation, the patient does not need to stay in the hospital for long.
 

Some treatments covered under the daycare facility are:
 

  • Dental surgery
  • Tonsillectomy
  • Chemotherapy
  • Cataract surgery
  • Dialysis
     

Before purchasing a health insurance policy, check the inclusions for hospital daycare coverage so that you do not have to face any unwanted hassles at the last minute.

OPD vs. Daycare - What is the Difference?

Daycare treatment and OPD can initially look the same, but there are many differences. A policyholder must know the fine line between the two to get the most out of their insurance policy.
 

  1. Degree of coverage
    Most health insurance plans provide coverage for daycare procedures. However, when it comes to OPD treatment, you need to check if it is specifically mentioned in your policy. The scope of hospital daycare coverage also varies from one policy to another. So, make sure that you inquire about the same before buying a health policy.

  2. Hospitalisation
    Hospital admission is the main difference between OPD and daycare. OPD procedures do not demand any hospitalisation. On the other hand, daycare procedures require hospitalisation for less than 24 hours.

  3. Coverage amount
    Daycare treatment coverage is included in health insurance to the limit of the sum insured. This coverage includes pre and post-hospitalisation expenses related to the daycare procedure. Conversely, OPD coverage comes with a sub-limit clause, which means you are eligible for coverage to a specific limit, beyond which you will need to pay yourself.

Claim Settlement Process

The claim process for daycare procedures is similar to regular hospitalisation. You can select a network hospital to avail of the cashless claim facility. Make sure you notify the insurance company about the treatment you have undergone and submit the required documents before filing the claim.
 

OPD treatment expenses can be claimed by submitting relevant documents. However, all insurance policies do not have a cover for OPD. Additionally,iIt can also be subject to a sub-limit.

Bottom Line

A health insurance plan has some terms and conditions. You must understand these clauses in detail to avoid any delay or challenges at the time of claim settlement. Knowing the meaning of daycare procedures and OPD treatment is beneficial for choosing the right insurance plan based on your needs.
 

Apart from the medical and financial benefits, a health insurance plan provides tax* savings under Section 80D. This section offers tax deductions on health insurance premiums, preventive medical checkups, and other medical expenses.

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Tata AIA Life Insurance

A joint venture between Tata Sons Pvt. Ltd. and AIA Group Ltd. (AIA),  Tata AIA Life Insurance  is one of the leading life insurance providers in India. We post everything you need to know about life insurance, tax savings and a variety of lateral topics such as savings and investments in this space. You can access and read a host of different blogs, articles and pages at the Tata AIA Life Insurance Knowledge Center or get in touch with us with any queries or questions!

View all posts by Tata AIA Life Insurance

Frequently Asked Questions

Do I need to buy additional daycare coverage with my health insurance?

Not necessarily. Most health insurance policies include daycare treatment coverage. Thus, there is no need for you to buy it separately. However, check your policy wordings to be sure.

Is there a limit on the claim amount for daycare procedures?

Generally, a health plan covers daycare treatment costs up to the total sum insured.

What does the OPD cover include?

OPD coverage takes care of doctor consultations, routine checkups, diagnostic tests, vaccinations, pharmacy expenses, small minor surgeries, etc.

Disclaimers

  • Insurance cover is available under the product.
  • The products are underwritten by Tata AIA Life Insurance Company Ltd.
  • The plans are not a guaranteed issuance plan, and it will be subject to Company’s underwriting and acceptance.
  • For more details on risk factors, terms and conditions please read the sales brochure carefully before concluding a sale.
  • This blog is for information and illustrative purposes only and does not purport to any financial or investment services and do not offer or form part of any offer or recommendation. The information is not and should not be regarded as investment advice or as a recommendation regarding any particular security or course of action.
  • Please know the associated risks and the applicable charges, from your Insurance agent or the Intermediary or policy document issued by the insurance company.
  • Every effort is made to ensure that all information contained in this blog is accurate at the date of publication, however, the Tata AIA Life shall not have any liability for any damages of any kind (including but not limited to errors and omissions) whatsoever relating to this material.
  • Tax: *Income Tax benefits would be available as per the prevailing income tax laws, subject to fulfilment of conditions stipulated therein. Income Tax laws are subject to change from time to time. Tata AIA Life Insurance Company Ltd. does not assume responsibility on tax implications mentioned anywhere in this document. Please consult your own tax consultant to know the tax benefits available to you.