They don`t tell you this about Day Care in health insurance

Mahavir Chopra

As a child, I was always told about the virtues of saving time. Finish your milk fast, finish your homework quickly so you can go out and play. Move faster, stop wasting time! As an adult, it’s still pretty much the same! Life is all about being more efficient and saving time. Medicine and healthcare are no exceptions. All the research and all the advancement is about being efficient: procedures are taking far lesser time than they earlier did, technology is helping in faster recuperation and so on.

The healthcare industry in India has seen a lot of progress in the last decade. Procedures such as angioplasty, gall bladder removal, cataract which would leave our parents and grandparents in the hospital for days, all take less than 24 hours today. While time taken for treatment and medical procedures is taking lesser and lesser time, is it getting cheaper? Well, not really! Just like a stylist takes money for a haircut irrespective of the time it took to give you that haircut, doctors also charge you a fairly high amount for procedures like cataract, appendicitis , angioplasty etc which now take far lesser time. Health Insurance generally covers hospital bills that involve at least 24 hours of hospitalization. So what happens to coverage of such procedures that now take less that 24 hours, but cost a lot still? Here’s where the concept of covering day care treatment come into play. Health Insurance generally cover the following treatments under day care: • Treatments that previously used to take more than 24 hours but now take less time due to technological advances such as Angioplasty, Cataract etc. • Minor Treatments that need hospital infrastructure to be carried out. For instance, treatments that require General Anesthesia such as benign tumor removal etc. There has been a lot of confusion on this concept. Over enthusiastic sales/marketing people from Insurance Companies/Brokers have always pushed customers to buy their products by stating how their plan had a longer list of day care procedures compared to others and had better coverage of day care procedures. Here are a few important points for you to consider before choosing a health insurance plan for you:• Day Care cannot and should not be evaluated by the number of procedures covered. • An Insurance company could have a list of only 20 treatments, but they could be very broad. For instance, Government Insurers list very broad treatments like "Surgery of the eye", whereas a private sector insurer may list this one category, into 17 detailed treatments under eye surgeries like "removal of foreign body from lens", "removal of foreign body from eyeball", "Cataract", etc. • Broad categorization with a smaller list, can actually be more beneficial, as they will be more inclusive. An insurance company which lists specific detailed list, may not cover a new treatment, as medical science advances rapidly and hence may not pay you in the future for new treatments covered under day care. • Unless you are medical professional, it would be difficult to understand the day care procedures listed in the policy document. Hence when comparing 2 plans with similar benefits and features, always opt for the one that has broader categorisation or better still, all inclusive day care procedures. Best policies keeping this in mind are listed below in order of my preference are: • Policies that cover "all day care" procedures: Apollo Munich Optima Restore, Max Bupa Heartbeat are some of the policies that don't have a specific list, and specifically mention that all day care procedures are covered. • Policies that cover categories:  All Government Insurers have categories of day care procedures listed. These are also good options to go with. The advantage here is that in case a category of day care procedure is not covered specifically at the time of buying the policy, you can request for inclusion of your specific unlisted procedure to the third party administrators before hospitalisation.• Policies that have a large list of day care procedures.

The author heads health, accident & life insurance at www.coverfox.com