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Difference between Daycare and OPD Treatments

A health insurance plan is important as it covers our medical costs which have become prohibitively expensive. Since a health plan provides us financial relief, most of us invest in a health plan for ourselves and our families. Though we buy the plan,  we ignore the all-too-important aspect of it – the fine print. Insurance, being a technical subject, confuses most of us and we ignore the common concepts of the plan. Take the example of Daycare treatments and OPD (outpatient) treatments under a health insurance plan. We believe that both these concepts are similar to each other. But, are they?

Actually, they are not! OPD treatments and Day care treatments are as different as apples and oranges. While they have one or two common factors, the similarities end there. Let us understand the concepts and their differences.

Day care treatments

To understand Day Care treatments, you should first know that to claim hospitalization expenses under your health insurance plan, you should be admitted in hospital for a minimum continuous period of 24 hours. Only then can you claim in-patient hospitalization expenses in your health plan. However, due to advanced medical technology, some treatments and procedures can be completed in a mere few hours and you can get discharged the same day. But, since you do not complete the 24-hour required hospitalization, would such treatments get covered?

Yes, such treatments do get covered and they are called day care treatments. In other words, day care treatments are those treatments which do not require hospitalization for 24 hours due to medical advancement.

Out-patient treatments (OPD treatments)

The normal doctor visits which you do in the doctor’s chamber or clinic and the treatments which you avail there are called OPD treatments. OPD treatments do not require hospitalization and can be done by the medical practitioner in his/her own clinic or consultation room.

So, do you see any similarities?

If you look closely, there is one similarity which you can say that Day Care and OPD treatments have. Both these treatments take a low time to get completed. Beyond the time similarity, nothing else is common between the two. Now, let’s see the differences.

Differences between OPD and Day Care treatments

  • Availability of coverage

Day care treatments are available in, almost, all health insurance plans whether the plan is the most basic plan or a comprehensive one. It forms the standard coverage feature of all health plans. OPD treatments, on the other hand, are, usually, included in the exclusion list of many health insurance plans. There are some advanced plans which allow OPD coverage in their scope of cover. Usually, such plans have a high Sum Insured limit and have a higher premium too.

  • Extent of coverage

Day care treatments are covered up to the Sum Insured. Barring one or two treatments (cataract, for instance), there is no limit on the coverage of such treatments. However, the number of day care treatments covered, vary across different plans.

OPD treatments, on the contrary, are always allowed with a sub-limit. They are never covered up to the Sum Insured.

  • Requirement of hospital admission

Day Care treatments would only be eligible to be covered if the treatment is taken after being admitted in a hospital. However, for OPD treatments, no hospitalization is required. Take the instance of corrective eye surgery called LASIK. You can take LASIK treatment either at the doctor’s clinic or after being hospitalized in a hospital. If you get the treatment at the clinic itself, it would be called an OPD treatment and claim would be settled as per the terms of the policy and mentioned sub-limits. However, if you take the same treatment after being hospitalized, it would be categorized as a Day Care Treatment and would be covered up to the Sum Insured.

So, is the picture clear to you?

Day care and OPD treatments are world apart and should not be confused with each other. While doctor consultations, medicines, pathological tests, etc. qualify for OPD expenses, common day care treatments include the following:

  • Cataract treatment

  • Tonsillectomy

  • Hemodialysis

  • Cystoscopical stone removal

  • Chemotherapy, etc.

The next time you are reading your health insurance brochure and come across the terms Day Care Treatments and OPD treatments, don’t get confused. Understand their meaning and their differences so that you don’t get into any troubles at the time of making a claim.

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