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Home >Money >Personal Finance >Daycare vs OPD: decoding treatments under a health policy

While buying a health insurance policy, many people tend to get confused due to the technicality of the subject. One such technical aspect is the difference between daycare treatment and outpatient department (OPD) treatment that a lot of people don’t know.

Hence, you must understand these terms to avoid any confusion while going through the features when you buy a health insurance policy.

HOSPITALIZATION

Daycare treatment is completed on the very same day or within a span of a few hours when the patient visits the doctor’s clinic or hospital.

“It strictly refers to treatments, surgeries and operations that require hospitalization below 24 hours of time, due to the technological advancement in the medicinal field and procedures related to it," said Indraneel Chatterjee, co-founder, RenewBuy Insurance.

However, not every daycare treatment is covered by all health policies; one must read the documents carefully to know which illness/diseases are covered under the daycare treatment. Some of the examples are cataract surgery, radio or chemotherapy, bone fracture, certain injury-related dental surgeries, coronary angiography, etc.

On the other hand, OPD treatments do not require the patient to get admitted to the hospital. Instead, this treatment needs the patient to visit the doctor’s clinic either for consultation, treatment or diagnosis for a specific disease or illness.

“OPD consultations required for smaller medical concerns like fractures, sprains and other doctor consultations are covered under OPD benefit or OPD cover, as specified in the health policy," said Chatterjee.

LEVEL OF COVERAGE

Under daycare procedures, there are no sub-limits. These treatments are covered for up to the sum assured level chosen by the insured. However, coverage for OPD treatments is within a sub-limit of your overall sum insured limit.

Rakesh Goyal, director, Probus Insurance, said, “For OPD treatments, one can claim the expenses incurred by submitting the relevant documents. For daycare treatments, the claim is similar to any other regular hospitalization. One can avail cashless facilities for claims (for network hospitals) or claim reimbursement by submitting the necessary documents (for non-network hospitals) for daycare treatments."

WAITING PERIODS

Under daycare treatments, any pre-existing condition will be covered only after serving the waiting period of three years except for any accidental injury. Also, there is a two-year waiting period for specific diseases like cataract, hernia, joint replacement surgeries, etc.

On the contrary, the waiting period for availing outpatient department benefit is quite less, i.e. 90 days. This way, you can claim OPD expenses within 90 days of taking a health insurance policy.

NATURE OFPROCEDURES

“Daycare treatments are costlier and benefit a person during an emergency or any major planned surgery like cataract, radiotherapy, chemotherapy, dialysis, angiography, etc," said Amit Chhabra, head - health insurance, Policybazaar.com.

“On the other hand, the OPD cover is best suited for individuals who figure they may incur medical care costs that don’t need in-patient hospitalization and demand regular visits like fever and chronic conditions like diabetes, arthritis or back pain," he said.

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