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HEALTH INSURANCE

Day Care Treatments Covered Under Health Insurance

Aniket Thakkar Aniket Thakkar 09 January 2016

Is it news to you that Day Care procedures like cataract operation are also covered under health insurance? Know more about this concept before buying your plan!

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Last week, Mr. Sharma's wife was diagnosed of tonsillitis. The doctors suggested a tonsillectomy surgery. The hospital also informed Mr. Sharma that it was a minor surgery and his wife would be discharged from the hospital on the very same day. Instead of feeling relieved, Mr. Sharma was disappointed fearing that his health insurance policy may not provide for the surgery. But when he cross-checked with his insurance broker, it was revealed that his policy would have provided for the treatment costs as the surgery fell under the category of Day Care procedures.

Intrigued? We are sure that like Mr. Sharma, you were also not fully aware of this concept.

Medical science has advanced leaps and bounds. Ailments for which a patient had to be hospitalized for days are now being cured in the matter of a few hours. To catch up with this changing face of technology, health insurance plans in India have also changed their scope of coverage. The concept of Day Care Treatments is available in almost all of the plans these days. This feature covers those treatments where even 24 hours of hospitalization is not necessary.

What are Day Care Treatments?

To give a technical definition, Day Care Treatments refer to those treatments that are done under a general or a local anesthesia in a hospital or in a day care center, and take less than 24 hours. There is a list of such treatments that are covered under the scope of your health plan.

What is actually covered?

Treatments that usually fall within the scope of a Day Care Treatment include:

  • Appendectomy
  • Angiography
  • Chemotherapy
  • Colonoscopy
  • Eye Surgery
  • Radiotherapy
  • Lithotripsy
  • Hydrocele
  • Piles / Fistula
  • Prostate
  • Sinusitis
  • Liver aspiration
  • Dialysis
  • Sclerotherapy

These are some of the most common procedures, while the actual list can be much longer. Moreover, the list of treatments covered depends on the plan you select. Let us take a look at the popular plans available in the market and the number of procedures each cover:

Apollo Munich's Optima RestoreAll Day Care Treatment Covered
Apollo Munich's Easy Health (All Variants)144 Day Care Treatment Covered
Star Health's Family Health Optima170 Day Care Treatment Covered
Max Bupa's Heartbeat PlanOver 400 Day Care Treatment Covered
New India's Family Floater Mediclaim PolicyAll Day Care Treatment Covered
National Parivar Mediclaim PlusOver 140 Day Care Treatment Covered

Health Insurance Companies offering Day Care Procedures As Follows

Following Health Insurance Companies Offer The Best Day Care Procedures In The Country:

Apollo Munich's Optima Restore

The Benefits Offered By Apollo Munich Optima Restore Are:

  • Complete Coverage
  • Restore Benefit
  • Multiplier Benefit
  • Stay Active Benefit
  • Cashless Claims
  • Day-Care procedures
  • Ambulance Cover
  • Emergency Air Ambulance Cover

A few of the day care treatments covered under the plan are:

  • Cancer Chemotherapy
  • Liver biopsy
  • Coronary angiography
  • Haemodialysis
  • Operation of cataract
  • asal sinus aspiration

Along with this it also provides coverage towards:

  • In-Patient Hospitalisation The medical expenses for coverage for hospitalization of more than 24 hrs with no room rent limits.
  • Pre-Hospitalisation The medical expenses that you incur due to illness during 60 days immediately before you are hospitalized.
  • Post-Hospitalisation The medical expenses you incur in the 180 days immediately after you are discharged from hospital.
  • Day-Care Procedures The medical expenses for all day-care procedures, which do not require 24 hours hospitalization due to technological advancement, are covered.
  • Domiciliary Treatment The treatment expenses involved in getting a treatment done at home which otherwise would need hospitalization.
  • Organ Donor Treatment expenses for the organ donor at the time of organ transplant.

The exclusions of the plan are mentioned below:

  • All treatments within the first 30 days of cover, except any accidental injury.
  • Any pre-existing condition will be covered after a waiting period of 3 years.
  • 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
  • Expenses arising from HIV or AIDS and related diseases.
  • Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments.
  • Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
  • Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
  • Pregnancy, dental treatment, external aids and appliances.
  • Items of personal comfort and convenience.
  • Experimental, investigative and unproven treatment devices and pharmacological regimens.

Note: All information has been sourced from Apollo Munich’s official website.

Religare's Care

With Care, you get following Key USPs which are not available anywhere else.

  • Annual Health Check-up for all members covered under the policy.
  • Up to 150% No Claim Bonus with NCB Super.
  • Unique Unlimited Automatic recharge.
  • Care anywhere – Global Cover for 12 Critical Illnesses.
  • Care is available with different riders, hence ability to fit your needs.

It provides coverage for 540 and more treatments covered in this plan; a few major heads of these treatments can be listed as under:

  • Cardiology related
  • Critical Care related
  • Urology related
  • Dental related
  • ENT related
  • Gastroenterology related
  • General Surgery related
  • Gynecology related
  • Neurology related
  • Oncology related
  • Operations on the salivary glands and salivary ducts
  • Operations on the skin & subcutaneous tissues
  • Operations on the tongue
  • Ophthalmology related
  • Orthopaedics related

1. From Diagnosis to Recovery - "Care" at every step!

The Company understands that the meter doesn't start from hospitalization but from the time of diagnosis and goes on even post discharge. They stand with you throughout the journey and not just for an event.

2. 30 Day Pre-Hospitalization Coverage

The procedures that you undergo before getting hospitalized finally lead you to a hospital, such as investigative tests and routine medication, can be quite financially draining. The Company covers the medical expenses incurred by you up to 30 days before your hospitalization.

3. Ambulance Cover

The Company reimburses expenses incurred by you while availing a domestic road ambulance during your hospitalization. Not just this, some plans of product care also offers coverage for availing an Air Ambulance if suggested by a doctor.

4. In-Patient Hospitalization

A). Hospitalization for at least 24 hours

The Company pays for – room charges, nursing expenses and intensive care unit charges, surgeon's fee, doctor's fee, anesthesia, blood, oxygen, operation theater charges, etc.; If you are admitted to a hospital for in-patient care, for a minimum period of 24 consecutive hours.

B). Hospitalization less than 24 Hours

The Company covers medical expenses if you undergo a day care treatment which might not require you to stay hospitalized for 24 hours or more. As a matter of fact we cover over 540+ day care procedures.

5. Room Rent

The Company reimburses every expense occurred while you're staying in a single or a private room. You can also upgrade your room should there be a need to and is recommended by a treating doctor.

6. ICU Charges:

The Company also takes care of ICU charges that come in your way of getting a quality treatment.

7. 60-Day Post – Hospitalization Coverage

The Company reimburses expenses such as doctor consultations, Diagnostic tests, medications etc. that you incur up to 60 days post your hospitalization.

**8. Domiciliary Hospitalization

In case of an emergency or a medical condition that does not allow you to get admitted in a hospital, the Company provides coverage for medical expenses incurred during your treatment at home for a period exceeding 3 consecutive days.

9. Annual Health Check-up

The Company gives an Annual Health Check-up for yourself and all members covered by your policy, including children.

10. Automatic Recharge of Sum Insured

If you ever run out of your health cover due to claims made, the Company will reinstate the entire Sum Insured amount of your policy. You can use this additional amount for any other ailment or by any other insured member for treatment of any ailment.

11. No-Claim Bonus

The Company raises a cheer to good health for every year that you don't claim by increasing your Sum Insured by 10%, up to a maximum of 50% in consecutive 5 years.

Organ Donor Cover

Beyond ensuring that your medical needs are met, the Company will reimburse you for medical expenses that are incurred by an organ donor while undergoing the organ transplant surgery.

Reassurance of Second Opinion

If, at any moment you feel uncertain about your diagnosis, you can opt for a second opinion at no extra cost specially arranged by the Company.

No Upper Age Limit of Enrolment

All the plans including 'care', come with no upper age limit of enrolment i.e. even if a person is 100 years old, they can definitely apply.

Lifelong Renewability

The Company doesn't leave you in between the journey and honor our commitment by giving their customers option of lifelong renewability i.e. once enrolled an individual can continue to stay covered throughout one's life, provided they renew their policy on time every year.

Alternate Treatments Coverage

Whether it is Ayurveda, Unani, Sidha or Homeopathy (AYUSH), choose the treatment that suits you and the Company will cover it up to a specified limit and varies according to the plan chosen.

Exclusions of the policy include

  • Any diagnosis of diseases / undergoing of surgery / occurrence of event, whose signs or symptoms first occur within 30 days of Policy Period Start date.
  • Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
  • Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
  • Medical expenses incurred for treatment of AIDS
  • Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
  • Congenital disease
  • Tests and treatment relating to infertility and in vitro fertilization.
  • War, riot, strike, nuclear weapons induced hospitalization

Note: All information has been sourced from Religare’s official website.

Star Health's Family Health Optima

Following are the Benefits of Star Health Family Health Optima Plan:

PORTABILITY

If you want to transfer the policy to another insurer, the plan allows you to do so without losing your accrued benefits after the waiting periods.

TAX BENEFITS

You can avail tax benefits for the premium amount paid towards this plan under Section 80D of the Income Tax Act, 1961.

HEALTH CHECK-UP

This plan offers health check-up benefit up to 1% of sum insured for a maximum of Rs.5,000 every three years for those with sum insured of Rs.3 lakh and above.

HOME HOSPITALIZATION/ DOMICILIARY HOSPITALIZATION

You can avail treatment at home up to the base sum insured exceeding three days. There are certain terms and conditions related to this privilege, and you can refer them in the policy wordings.

SUM ASSURED ENHANCEMENT

You can apply for an increase in the sum assured at the time of renewal. However, there should not be any claim made on the policy for considering the request.

EMERGENCY AMBULANCE

Compensates you up to Rs.750 for each hospitalization towards the emergency ambulance services up to a maximum of Rs. 1,500 per policy period. The following treatments are covered in the plan:

DAY CARE TREATMENTS

The plan covers the expenses towards 405 day-care procedures that would otherwise require hospitalization of a minimum of 24 hours.

NO-CLAIM BENEFITS

Depending on the sum insured you have opted, for every claim free year, you will be entitled to a bonus of up to 35% of your sum insured.

ORGAN DONOR COVER

If you are the recipient, then the expenses for organ transplantation will be paid up to 10% of the sum insured or Rs.1 lakh (whichever is less) subject to the availability of the sum insured.

PRE HOSPITALIZATION

Compensates for the Pre-Hospitalisation expenses for consultations, investigations and medicines incurred up to 60 days before Hospitalisation

POST HOSPITALIZATION

Compensates for the Post-Hospitalization expenses for consultations, investigations and drugs incurred up to 90 days after discharge from Hospitalization.

RESTORE BENEFITS

For sum insured of Rs.3 lakh and above, there is 100% automatic restoration of the sum insured in case the original is exhausted.

RECHARGE BENEFIT

This plan has recharge benefit which would get activated even when the entire sum insured is not exhausted, and the claim is raised for the same illness. This benefit is applicable for sum insured in the range of Rs.3 lakh and Rs.5 lakh. The recharge amount is in the range of 15% to 30% of sum insured depending on the zone and sum insured opted. Note: Both the restore and recharge can be used up for the same hospitalization.

The Plan will not cover any liabilities towards the treatments of following conditions:

  • Intentional self-injury
  • Mental illness
  • Cosmetic, aesthetic treatment
  • Dental surgery
  • AIDS
  • Pregnancy, childbirth, miscarriage, and abortion
  • Congenital disease
  • Infertility and in vitro fertilization.
  • Hospitalization out of war, riot, strike and nuclear weapons

Note: All information has been sourced from Star Health’s official website.

Max Bupa's Heartbeat Plan

Following are the benefits of Max Bupa HeartBeat Plan:

  • In-patient care (hospitalization)
  • Alternative treatments
  • All day care treatment covered
  • Maternity benefits
  • Newborn baby
  • Any age enrollment
  • Loyalty additions
  • Hospital cash
  • Health check-up
  • Organ transplant
  • Domiciliary hospitalization
  • Emergency ambulance
  • Free look period

Mentioned below are the Exclusion of this plan:

  • Artificial life maintenance
  • Ancillary Hospital Charges
  • Autoimmune Disorders
  • Hazardous Activities
  • Behavioural, Neurodevelopmental and Neurodegenerative Disorders
  • Circumcision
  • Complementary & Alternative Medicine
  • Conflict & Disaster
  • Congenital Anomaly, Hereditary or Genetic Disorders
  • Convalescence & Rehabilitation
  • Cosmetic and Reconstructive Surgery
  • Dental/oral treatment
  • Eyesight & Optical Services
  • Experimental/Investigational or Unproven Treatment
  • HIV, AIDS, and related complex
  • Hospitalization not justified
  • Inconsistent, Irrelevant or Incidental Diagnostic procedures
  • Mental and Psychiatric Conditions
  • Non-Medical Expenses
  • Obesity and Weight Control Programs
  • Off- label drug or treatment
  • Puberty and Menopause related Disorders
  • Reproductive medicine & other Maternity Expenses: Any assessment or treatment method
  • Robotic Assisted Surgery, Light Amplification by Stimulated Emission of Radiation (LASER) & Light based Treatment
  • Sexually transmitted Infections & diseases
  • Sleep disorders
  • Substance related and Addictive Disorders
  • Traffic Offences & Unlawful Activity
  • Treatment received outside India
  • Unrecognized Physician or Hospital
  • Any costs or expenses specified in the list of expenses generally excluded at Annexure IV of policy wording

Note: All information has been sourced from Max Bupa’s official website.

New India's Family Floater Mediclaim Policy

A few of the Day Care Treatments covered in this policy are:

1 Stapedotomy

2 Excision And Destruction of a Lingual Tonsil

3 Stapedectomy

4 Other Operations on the Tonsils and Adenoids

5 Revision of a Stapedectomy

6 Incision on Bone, Septic and Aseptic

7 Other Operations on the Auditory Ossicles

8 Closed Reduction on Fracture, Luxation or Epiphyseolysis with Osteosynthesis

9 Myringoplasty (Type -I Tympanoplasty)

10 Suture And Other Operations on Tendons and Tendon Sheath NIAHLIP18017V021718

11 Tympanoplasty (Closure of an Eardrum Perforation/Reconstruction of the Auditory Ossicles)

12 Reduction of Dislocation under Ga

13 Revision of a Tympanoplasty

14 Arthroscopic Knee Aspiration

15 Other Microsurgical Operations on the Middle Ear

16 Incision of the Breast

17 Myringotomy

18 Operations on the Nipple

19 Removal of a Tympanic Drain

20 Incision And Excision of Tissue in the Perianal Region

21 Incision of the Mastoid Process and Middle Ear

22 Surgical Treatment of Anal Fistulas

23 Mastoidectomy

24 Surgical Treatment of Haemorrhoids

25 Reconstruction of the Middle Ear

26 Division of the Anal Sphincter (Sphincterotomy)

27 Other Excisions of the Middle and Inner Ear

28 Other Operations on the Anus

29 Fenestration of the Inner Ear

30 Ultrasound Guided Aspirations

31 Revision of a Fenestration of the Inner Ear

32 Sclerotherapy

33 Incision (Opening) And Destruction (Elimination) Of the Inner Ear

34 Incision of the Ovary

35 Other Operations on the Middle and Inner Ear

36 Insufflation of the Fallopian Tubes

37 Excision And Destruction of Diseased Tissue of The Nose

38 Other Operations on the Fallopian Tube

39 Operations on the Turbinates (Nasal Concha)

40 Dilatation of the Cervical Canal

41 Other Operations on the Nose

42 Conisation of the Uterine Cervix

43 Nasal Sinus Aspiration

44 Other Operations on the Uterine Cervix

45 Incision of Tear Glands

46 Incision of the Uterus (Hysterotomy)

47 Other Operations on the Tear Ducts

48 Therapeutic Curettage

49 Incision of Diseased Eyelids

50 Culdotomy

51 Excision And Destruction of Diseased Tissue of the Eyelid

52 Incision of the Vagina

53 Operations on the Canthus and Epicanthus

54 Local Excision And Destruction of Diseased Tissue of The Vagina And The Pouch Of Douglas

55 Corrective Surgery for Entropion and Ectropion

56 Incision of the Vulva

57 Corrective Surgery for Blepharoptosis

58 Operations on Bartholin’S Glands (Cyst)

59 Removal of a Foreign Body from the Conjunctiva

60 Incision of the Prostate

61 Removal of a Foreign Body from the Cornea

62 Transurethral Excision And Destruction of Prostate Tissue

63 Incision of the Cornea

64 Transurethral and Percutaneous Destruction of Prostate Tissue

65 Operations for Pterygium

66 Open Surgical Excision And Destruction of Prostate Tissue NIAHLIP18017V021718

67 Other Operations on the Cornea

68 Radical Prostatovesiculectomy

69 Removal of a Foreign Body from the Lens of the Eye

70 Other Excision and Destruction of Prostate Tissue

71 Removal of a Foreign Body from the Posterior Chamber of the Eye

72 Operations on the Seminal Vesicles

73 Removal of a Foreign Body from the Orbit and Eyeball

74 Incision And Excision of Periprostatic Tissue

75 Operation of Cataract

76 Other Operations on the Prostate

77 Incision of a Pilonidal Sinus

78 Incision of the Scrotum and Tunica Vaginalis Testis

79 Other Incisions of the Skin and Subcutaneous Tissues

80 Operation on a Testicular Hydrocele

81 Radiotherapy for Cancer

82 Cancer Chemotherapy

For more information: Kindly refer to the policy document

The Exclusions under the policies are:

  • 1 Treatment of any Pre-existing Condition/Disease, until 48 months of Continuous Coverage of such Insured Person have elapsed, from the Date of inception of his/her first Policy with Us as mentioned in the Schedule.

  • 2 Any Illness contracted by the Insured person during the first 30 days of the commencement date of this Policy. This exclusion shall not however, apply if the Insured person has Continuous Coverage for more than twelve months.

  • 3.1 Unless the Insured Person has Continuous Coverage in excess of twenty four months with us, expenses on treatment of the following Illnesses are not payable:
  1. All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps

  2. Benign ear, nose, throat disorders

  3. Benign prostate hypertrophy

  4. Cataract and age related eye ailments

  5. Diabetes Mallitus

  6. Gastric/ Duodenal Ulcer

  7. Gout and Rheumatism

  8. Hernia of all types

  9. Hydrocele

  10. Hypertension

  11. Non Infective Arthritis

  12. Piles, Fissures and Fistula in anus

  13. Pilonidal sinus, Sinusitis and related disorders

  14. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from Accident

  15. Skin Disorders

  16. Stone in Gall Bladder and Bile duct, excluding malignancy

  17. Stones in Urinary system

  18. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus

  19. Varicose Veins and Varicose Ulcers

Note: Even after twenty four months of Continuous Coverage, the above illnesses will not be covered if they arise from a Pre-existing Condition, until 48 months of Continuous Coverage have elapsed since inception of the first Policy with the Company.

  • 3.2 Unless the Insured Person has Continuous Coverage in excess of forty eight months with us, the expenses related to treatment of
  1. Joint Replacement due to Degenerative Condition, and

  2. Age-related Osteoarthritis & Osteoporosis are not payable.

4.1 Injury / Illness directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like operations (whether war be declared or not), nuclear weapon/ ionising radiation, contamination by Radioactive material, nuclear fuel or nuclear waste or from the combustion of nuclear fuel.

4.2 a. Circumcision unless necessary for treatment of a Illness not excluded hereunder or as may be necessitated due to an accident

b. Change of life or cosmetic or aesthetic treatment of any description such as correction of eyesight, etc. c. Plastic Surgery other than as may be necessitated due to an accident or as a part of any Illness.

4.3 Vaccination and/or inoculation

4.4 Cost of braces, equipment or external prosthetic devices, non-durable implants, eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants, durable medical equipment.

4.5 Dental treatment or Surgery of any kind unless necessitated by accident and requiring Hospitalisation.

4.6.1 Convalescence, general debility, 'Run-down' condition or rest cure, obesity treatment and its complications, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, Venereal disease, intentional self-injury and Illness or Injury caused by the use of intoxicating drugs/alcohol.

4.6.2 Congenital Internal and External Disease or Defects or anomalies

However, the exclusion for Congenital Internal Disease or Defects or anomalies shall not apply after twenty four months of Continuous Coverage, if it was unknown to You or to the Insured Person at the commencement of such Continuous Coverage. Exclusion for Congenital Internal Disease or Defects or Anomalies would not apply to a New Born Baby during the year of Birth and also subsequent renewals, if Premium is paid for such New Born Baby and the renewals are effected before or within thirty days of expiry of the Policy. The exclusion for Congenital External Disease or Defects or anomalies shall not apply after forty eight months of Continuous Coverage, but such cover for Congenital External Disease or Defects or anomalies shall be limited to 10% of the average Sum Insured in the preceding four years.

4.7 Bodily Injury or Illness due to willful or deliberate exposure to danger (except in an attempt to save human life), intentional self-inflicted Injury, attempted suicide.

4.8 Treatment of any Bodily Injury or Illness sustained whilst or as a result of active participation in any hazardous sports of any kind.

4.9 Treatment of any Injury or Illness sustained whilst or as a result of participating in any criminal act.

4.10 Sexually Transmitted Diseases, any condition directly or indirectly caused to or associated with Human T-Cell Lymphotropic Virus Type III (HTLB - III) or lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.

4.11 Charges incurred at Hospital primarily for diagnosis, x-ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any Illness or Injury for which confinement is required at a Hospital.

4.12 Expenses on vitamins and tonics unless forming part of treatment for Injury or Illness as certified by the attending physician.

4.13 Maternity Expenses, treatment arising from or traceable to pregnancy, miscarriage, abortion or complications; except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and Certification by Gynaecologist that it is life threatening one if left untreated.

4.14 Naturopathy Treatment.

4.15 External and or durable Medical / Non-medical equipment of any kind used for diagnosis and or treatment including CPAP (Continuous Positive Airway Pressure), Sleep Apnoea Syndrome , CPAD (Continuous Peritoneal Ambulatory Dialysis), Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Belts, Collars, Caps, Splints, Slings, Stockings, elastocrepe bandages, external orthopaedic pads, sub cutaneous insulin pump, Diabetic foot wear, Glucometer/Thermometer, alpha/water bed and similar related items etc., and also any medical equipment, which is subsequently used at home.

4.16 Genetic disorders and stem cell implantation/Surgery.

4.17 Domiciliary Hospitalisation

4.18 Acupressure, acupuncture, magnetic therapies

4.19 Experimental or unproven treatments/therapies

4.20 Any expenses relating to cost of items detailed in Annexure I of Policy Document.

4.21 Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by the Hospital.

4.22 Treatment for Age Related Macular Degeneration (ARMD) , treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR),

External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy

Note: All information has been sourced from New India’s official website.

National Parivar Mediclaim Plus

Salient features and benefits of National Parivar Mediclaim Plus plan are as follows:

  • Organ donor’s expenses are covered. Also, the plan reimburses costs for vaccination for the children till the age of 12 years.
  • Maternity benefit is available after having completed two years. Also, infertility treatment cost (up to Rs. 50,000) or infant is covered under the health plan. The cover comes with Rs. 30,000 for normal delivery and Rs. 50,000 for caesarean delivery, along with daycare process and OPD charges.
  • Non-allopathic treatments are generally not covered under basic health insurance plans. However, here you can get insurance coverage against Homeopathy and Ayurveda. Keep in mind to get treated at a recognised hospital for unlocking the benefit.
  • Medical emergency and air ambulance expenses are also covered under the National Parivar Mediclaim Policy Plus online. The pre-hospitalisation charge is covered for 30 days and post-hospital is for 60 days.
  • One medical second view for critical disorders within 1 policy period.
  • 140+ day care procedures are covered

The policy excludes the following:

  • HIV/AIDS
  • Congenital disorders
  • Alcohol addiction or substance use
  • Cosmetic procedure, plastic surgery or sex change operation

Note: All information has been sourced from National’s official website.

Points to be Noted

  • Treatments taken in the out-patient department (OPD) are not considered under Day Care Treatments. So a dental clean up would be considered as an OPD procedure while a dental surgery would be reimbursed as a day care procedure. There is a fine line of difference between Day Care treatments and OPD that must be understood to make rightful claims.

  • The method of making claim for Day Care procedures is the same as making claim for regular hospitalization. You would have to inform the respective third-party assistants (TPA) about the treatment in advance in case of a planned surgery. In case of emergency treatments, the TPA must be informed within the first 24 hours.

  • Do not buy a health insurance policy on the basis of the day care procedures covered in the plan. Some insurance companies count only the broader concepts, while segregate them further, thus taking the actual count higher in the policy wordings.

After this discussion, our Mr. Sharma was also delighted to understand this seemingly simple feature of his health plan that he had earlier ignored. Nevertheless, always remember to read the policy document carefully and consider all possible parameters before buying a health insurance plan.

List of Health Insurance Plans for NRIs

  • Royal Sundaram - Lifeline Elite: The Lifeline Elite Plan is a holistic health insurance plan designed for globe trotters. Any individual over 18 years of age can avail this plan. It is offered as an individual plan and as a family floater plan for self, spouse and children.
  • Religare Health Insurance - Care: Care is a comprehensive health insurance plan that can be availed to meet one's healthcare needs. Under the plan's Global Plus option, one has the facility of availing global coverage.
  • ManipalCigna - ProHealth Insurance Premier Plan: The Premier Plan provides a high coverage along with world class end-to-end benefits from in-hospital care to home care. Additionally, the plan offers unlimited restoration and a worldwide emergency cover.

NRIs - Eligibility Criteria for Health Insurance

The eligibility criteria for NRIs to avail a health insurance cover will differ from company to company. Besides the submission of the above-mentioned documents, an individual’s age plays a big role in determining whether or not coverage will be extended. Normally, insurance companies insist that an applicant be at least 18 years of age. Additionally, they may refuse to extend the policy protection in case the individual is over 65 years. For insuring children, the entry age is usually set at 91 days.

Documents to be Submitted by NRIs Applying for Health Insurance

NRIs are required to submit proof of residence, passport copy and PAN card copy while applying for health insurance in India. If an individual is not able to produce these documents, he or she may be denied access to health insurance coverage in the country.

FAQ's On Day Care Treatments

What Is Hospital Daycare?

Hospital daycare is the practice of planned admission to treat certain ailments that would not require more than a days’ hospitalisation. This reduces hospital care cost and reduces surgical waiting time, thereby minimally disrupting a patient’s lifestyle.

Is Daycare Covered By Insurance?

Yes, certain daycare treatments that would require a day’s attendance are covered under insurance.

Are procedures that require less than 24 hours hospitalization day care procedures covered?

Yes, some treatments that require less than 24 hours of hospitalisation can be covered under certain plans in insurance.

What is Day Care Procedure Benefit?

Day Care Procedure Benefit is the ease of treatment an ailment within 24 hours, thereby requiring hospitalisation of less than a day. This has proved to be beneficial for patients as they can now be treated and discharged within a day.

How to Choose Day Care Health Insurance Plan?

There are a number of factors an individual must consider before zeroing in on a Day Care Health insurance plan. Some of them are provision of cashless facility, age limit, sub limit, co-payment etc.

Aniket Thakkar
Written by Aniket Thakkar
He lives off TV shows, movies, junk food, comics and sarcasm. When he is not working as a freelance imaginary friend to other beings like him, he works as VP of Marketing at Coverfox.