OPD Treatment vs. Day Care Treatment
When buying health insurance, many features and terminologies need to be understood. Features like adequate sum insured, OPD treatment coverage, claim settlement process, premium payable, and day care treatment cover, along with inclusions and exclusions, help you choose the right policy.
Often, when purchasing a policy, people overlook essential features, focusing only on the sum insured and premium. Ignoring these important aspects can imbalance your finances and deplete your savings.
One such technical aspect, often misunderstood, is the difference between day care treatment and Outpatient Department (OPD) treatment.
Read on to understand the difference between day care treatment and OPD treatment.
What Is an OPD Treatment?
An Out-Patient Department (OPD) is a hospital facility where patients visit doctors for consultations without requiring hospitalization. This includes visits to diagnostic centers, consultation rooms, pharmacies, and other medical facilities within the hospital.
What Is Covered Under OPD Treatments?
- Diagnostic tests & X-rays
- Doctor's fees
- Routine check-ups & vaccinations
- Minor surgeries
- Dental treatments
What Is a Day Care Treatment?
A day care treatment refers to medical procedures requiring hospitalization for less than 24 hours. Common day care treatment procedures include dialysis, dental surgery (following an accident), chemotherapy, cataract surgery, and tonsillectomy.
What Is Covered Under Day Care Treatments?
- Cataract operation
- Nasal sinus aspiration
- Glossectomy
- Lithotripsy
- Coronary angiography
- Haemodialysis
- Radiotherapy
- Chemotherapy
- Joint and bone surgery
What Is the Difference Between OPD Treatment and Day Care Treatment?
While the difference between OPD and day care treatments might seem minor, understanding it is crucial before buying a health insurance policy. Continue reading to learn more:
| Parameters | Day Care Treatments | OPD Treatments |
|---|---|---|
| Hospitalization Type | Day care procedures require hospitalization for a few hours, typically less than 24 hours. | OPD treatment does not require hospitalization. |
| Level of Coverage | No 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 Procedure | These treatments are generally costlier and can be used during emergencies or planned surgeries like dialysis, cataract, radiotherapy, or chemotherapy. | Such treatments are ideal for individuals who do not need in-patient hospitalization and require regular visits for conditions like fever, diabetes, or arthritis. |
| Waiting Periods | Treatments can be availed only after serving a waiting period of three years, except for accidental injuries. | Treatments can be availed after serving a waiting period of only 90 days. |
Example
Root canal treatment is a good example to understand OPD treatment. It can be performed in a clinic or hospital without admission. Since no hospitalization (even for a few hours) is involved, this falls under OPD treatments. Conversely, a dental surgery resulting from an accident might require a few hours of hospitalization. As hospitalization for a few hours is involved, this treatment falls under day care treatments.
Claim Settlement for Day Care and OPD Treatments
Understanding the claim settlement process for both procedures is as important as understanding the terminologies themselves. Keep reading to know more:
Claim Settlement Under Day Care Treatments
- Most day care procedures are planned, allowing you to avail cashless claims by visiting a network hospital.
- Inform your health insurance provider in advance and submit all necessary documents.
- Once approved, your insurance company will handle your bills directly.
- If the procedure is conducted at a non-network hospital, you can claim reimbursement by submitting documents within 7 days, as per your insurer's terms and conditions.
Claim Settlement Process Under OPD Treatments
- OPD coverage is generally indemnity-based and comes with a sub-limit.
- After treatment, submit all necessary documents to your insurance provider.
- Once the sub-limit criteria are met, your health insurance company will reimburse the amount you paid.
Conclusion
Both OPD and day care treatments are essential components of health insurance. Before buying a health insurance plan, it is crucial to understand these terms thoroughly. This understanding will minimize delays or complexities during claim settlement and help you choose a best health insurance plan for your requirements.
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