OPD vs Day Care
Treatment
  • Difference b/w OPD & Day-Care Treatment
  • Coverage under Day Care Treatments
  • Coverage under OPD Treatments
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OPD Treatment vs Day Care Treatment

While buying health insurance, there are so many features & terminologies that should be kept in mind & well understood. Features such as adequate sum insured, OPD treatment coverage, claim settlement process, premium payable, daycare treatment cover, all inclusions and exclusions and so on, are the few things that help you decide the kind of policy you want to invest in.

Often at the time of purchasing the policy, people ignore the need for other essential features of the policy and only concentrate on the Sum Insured and Premium. Overlooking the important features of your policy may imbalance your finances and can wipe away all your savings.

One such technical aspect is the difference between Daycare Treatment and Outpatient Department (OPD) treatment that a lot of people don’t know.

Read ahead to find the difference between daycare reatment and OPD treatment.

What is an OPD Treatment?

Out-Patient Department (OPD) is a facility where patients can come to the hospital for doctors’ consultation regarding their health issues. Under OPD, it is not necessary for patients to get hospitalized. One can visit any medical facility such as a diagnostic center, consultation room, pharmacy and many more in the hospital for an OPD.

What is Covered Under OPD Treatments?

  • Diagnostic tests & X-rays
  • Doctor's fees
  • Routine check-ups & vaccinations
  • Minor surgeries
  • Dental treatments

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What is a Day Care Treatment?

A Day Care Treatment refers to the medical procedures that require hospitalization of less than 24-hours. Some of the common Day care Treatment procedures include dialysis, dental surgery (following an accident), chemotherapy, cataract surgery, tonsillectomy, etc.

What is Covered Under Day-Care Treatments?

  • Cataract operation
  • Nasal sinus aspiration
  • Glossectomy
  • Lithotripsy
  • Coronary angiography
  • Haemodialysis
  • Radiotherapy
  • Chemotherapy
  • Joint and bone surgery

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What is the Difference b/w OPD Treatment and Day-Care Treatment?

Generally, the difference between OPD treatments and Daycare treatments may not seem like much, however, there is plenty you need to be informed of before buying a health insurance policy. Continue reading to find more:

ParametersDay-care TreatmentsOPD Treatments
Hospitalization TypeDay Care procedures require the patient to stay in the hospital for a few hours, effectively less than 24 hours.OPD treatment does not require hospitalization
Level of CoverageNo sub-limits. Treatment costs are covered up to the chosen sum insured.Comes with a sub-limit of your overall sum insured limit.
Nature of ProcedureThese treatments are generally costlier and can be used during an emergency or any planned surgery like dialysis, cataract, radiotherapy, chemotherapy, etc.Such treatments are ideal for those individuals who donot need in-patient hospitalization and demand regular visits for fever and chronic conditions like diabetes, or arthritis.
Waiting PeriodsTreatments can be availed only after serving the waiting period of three years except for any accidental injury.Treatments can be availed by serving the waiting period of only 90 days.

Example

Root Canal treatment is the best way to understand the concept of OPD treatment. Root Canal treatment can be done in a clinic or a hospital without actually being admitted. As there is no hospitalization (even for a few hours), this kind of treatment falls under the category of OPD Treatments. On the other hand, a dental surgery resulting from an accident might require a few hours of hospitalization for the treatment. As hospitalization for a few hours is involved, this treatment falls under the category of Day Care Treatments.

Claim Settlement for Day Care and OPD treatments

Understanding the Claim Settlement Process of both procedures is as important as understanding these two terminologies. Keep reading to know more:

Claim Settlement Under Day Care Treatments:

  • Mostly, day-care procedures are planned in nature, thus one can avail the cashless claims by visiting the nearest network hospital.
  • Intimate your health insurance provider in advance and submit all the necessary documents.
  • Once approved, your insurance company will handle all your bills.
  • However, if the procedure is conducted at a non-network hospital, you can claim reimbursement by submitting the documents within 7 days depending upon the terms and conditions of your insurer.

Claims Settlement Process Under OPD Treatments:

  • The coverage under the OPD is generally indemnity-based and comes with a sub-limit.
  • Once you are done with the treatment, submit all the necessary documents to your insurance provider.
  • Once the sub-limit criteria are met, your health insurance company will reimburse the amount paid by you.

Conclusion:

OPD & Day Care Treatment, both are an essential part of a health insurance. Before buying a health insurance plan it is essential for you to understand these two associated terms thoroughly. Not only will it minimize any delays or complexity during claim settlement, but will also help you to choose a best health insurance plan as per your requirements.

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Reviewed By : Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.