Daycare Treatment — Covered Without 24-Hour Admission

Modern medicine has made many procedures that once required overnight admission possible as same-day treatments. IRDAI requires all health policies to cover these daycare procedures.

What Is Daycare Treatment

The IRDAI Definition

Daycare treatment refers to medical procedures undertaken under general or local anaesthesia in a hospital or daycare centre in less than 24 hours, because of technological advancement, and which would have otherwise required hospitalisation of more than 24 hours. Treatment normally taken on an outpatient basis is not included.

Key requirement: The procedure must require anaesthesia and would historically have needed admission. Routine outpatient consultations do not qualify as daycare treatment.

Commonly Covered Procedures

What You Can Claim Without Overnight Stay

Procedures commonly covered as daycare include: cataract surgery, chemotherapy sessions, radiotherapy, dialysis, lithotripsy (kidney stone removal), tonsillectomy, D&C, dental surgery under anaesthesia due to accident or cancer, hydrocele, and various endoscopic procedures requiring anaesthesia.

Before your procedure: Call your insurer or TPA and specifically confirm that your planned daycare procedure is covered and what pre-authorisation is required. Get confirmation in writing.

Claim Process for Daycare

Documentation Requirements

For daycare claims you will need: the admission and discharge record, the doctor's prescription recommending the procedure, the procedure report or operation notes, the itemised bill and receipt, and pre-authorisation approval from the TPA if cashless.

Investigation vs treatment: If the daycare visit was primarily for diagnostic purposes and no treatment was administered, it may not be claimable. The procedure must involve active medical intervention.

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