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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.
- 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.
- 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.
- 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.
