Health insurance is provided to employees to offer financial protection against medical expenses, subject to policy terms. However, many of us are perplexed when we see OPD and daycare listed as coverage options under our health insurance policies.
A visit to a hospital is typical to both OPD and daycare treatments. However, insurance policies treat them differently. If you don't know this difference, your insurance claims may get denied. We will explain the difference below.
What Is OPD in Health Insurance?
OPD stands for Outpatient Department.
How OPD Works
OPD stands for Outpatient Department, which means you go to a doctor and come back home on the same day without being admitted to the hospital.
What Comes Under OPD?
The cost incurred in OPD usually comprises:
- Fees for Consulting a Doctor
- Blood tests and scans
- X-rays and ECG
- Medicines purchased at a pharmacy
- Doctor visits for follow-up
Is OPD Covered under Employee Health Insurance?
However, in most employer-provided health insurance policies, OPD charges are not covered. As a result, the charges must be borne by the employees. Offering OPD coverage is an additional benefit from some firms, but it is limited to a set annual amount.
What Is Daycare in Health Insurance?
Daycare treatment refers to medical procedures that require hospital admission but do not require a stay of more than 24 hours.
Why Daycare Treatments Exist
There is improved medical technology. Some treatments require patients to stay in the hospital for several days, while others can be completed in hours. You can be admitted in the morning and be discharged on the same day.
Some of the daycare procedures include:
Common daycare procedures in health insurance are:
- Cataract Surgery
- Dialysis
- Chemotherapy and Radiotherapy
- Tonsil surgery
- Minor eye surgery
- Some heart-related procedures
Even during this short stay, these patients require operating theatres and hospital services.
Do Procedures at Daycare Centres Fall under Health Insurance?
Yes. Most health insurers cover daycare procedures. Insurance firms consider them a regular hospitalization procedure, even if only a few hours of hospitalization are required. This is why it is essential to understand daycare procedures related to health insurance.
Differences between OPD and Daycare
The Main Difference Is the Process of Admission
- OPD: No hospital admission
- Daycare: Required hospital admission
Insurance Coverage
- OPD: Primarily Not Covered
- Daycare: Mainly covered
Cashless Facility
- OPD: Normally not cashless
- Daycare: Cashless Available at Network Hospitals
Common Errors Made by Workers
Employees believe their health insurance only covers hospitalization after at least 24 hours. This is not true. If your treatment is listed in your health insurance's daycare procedures, it will also be covered, even if you are discharged on the same day. Another error is failing to review policy details. It is essential to check what is covered by your employer's plan.
What Employers Should Look for in Their Policy
Before you use your health insurance, you must check:
- Whether OPD is covered or excluded?
- Check the list of daycare procedures covered under the policy.
- Any limits or waiting periods
- Cashless hospital network
Conclusion
In simple terms, OPD refers to regular doctor visits and is typically paid by the employee. Daycare is used for short hospitalizations and is reimbursed primarily by health or medical insurance. Once workers understand the two concepts, using health insurance becomes much simpler.
