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    Health Insurance

    Daycare Procedures Under Health Insurance

    HealthGuard

    Key Features

    An All-rounder GST Free Health Cover to Guard Your Family

    Coverage Highlights

    Get comprehensive coverage for your health
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    • Choose from Best of Plans

    Choose from multiple plans to meet your requirements

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    • Wide Sum Insured Options

    Select adequate sum insured that suits you starting INR 3 lacs to INR 1 crore

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    • Unlimited Reinstatement Benefit & Recharge

    Get the option of unlimited reinstatement of sum insured even after it is exhausted after claims

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    • Maternity & Newborn Care

    Medical expenses related to delivery of baby and towards treatment of the new born baby are covered under select plans

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    • Preventive Health Check-Up

    Start receiving annual preventive health check-ups after 2/3 policy renewals as per the chosen plan

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    • Online Discount

    Get flat 5% discount when you buy a policy on our website or our Bajaj General App

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    • Zone Discount

    Avail discounts of 20% for Zone B and 30% for Zone C depending on where you live

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    • Fitness Discount & Wellness Discount

    Avail up to 12.5% wellness discount for healthy habits on renewal

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    • Note

    Please read policy wording for detailed terms and conditions

    Inclusions

    What’s covered?
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    • Hospitalisation & Day Care Expenses

    Coverage for the cost of in-patient hospitalisation (including room rent type choices), all types of day care procedures, and surgeries

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    • Pre & Post-Hospitalisation Expenses

    Pre-hospitalisation expenses (up to 60 days) and post-hospitalisation expenses (up to 90 days) are covered as per policy terms

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    • Organ Donor Expenses

    Medical expenses for an organ donor’s in-patient treatment during organ harvesting are covered, provided the insured is the recipient of the donated organ

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    • AYUSH Hospitalization cost

    Coverage for ayurvedic, yoga, unani, siddha and homeopathic (AYUSH) treatment on a doctor’s advice for treating illness or physical injury

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    • Maternity & Newborn Care

    Medical expenses related to delivery of baby and towards treatment of the new born baby are covered under select plans

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    • Sum Insured Reinstatement

    Exhausted sum insured exhausted or SI will be reinstated so that you can avail full coverage for your next claim in a policy year (as per policy terms) if needed

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    • Recharge (For SI 5 Lacs Onwards)

    If an unfortunate claim exhausts Sum Insured limit, the then additional amount of 20% Sum Insured (up to 25 INR lacs) will be available

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    • Cumulative Bonus

    Sum Insured automatically increases at renewal by opted percentage if there is no claim in expiring period

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    • Floater & Individual Sum Insured

    Option to cover your family members under shared SI in case of a floater plan or separate SI in case of an individual plan

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    • Note

    Please read policy wording for detailed terms and conditions

    Exclusions

    What’s not covered?
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    • Initial Waiting Period

    Treatment expenses during the first 30 days except for treatment of accidental injuries

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    • Pre-Existing Diseases

    Treatment expenses for pre-existing diseases such as diabetes, asthma, thyroid and other PED, are excluded until 36 months from date of your first Health Guard Policy

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    • Specific Illness Treatment

    Treatment expenses for specified illnesses, including hernia, gout, endometriosis, and cataract are excluded until 24 months from date of your first Health Guard Policy

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    • Maternity Expenses

    Treatment expenses related to maternity are excluded until 72 months from date of your first Health Guard Policy

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    • Expenses for Medical Investigation & Evaluation

    Medical expenses primarily for diagnostic procedures and medical evaluation unrelated to the current diagnosis or treatment

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    • Dietary Supplements & Substances

    Cost of supplements that are purchased without a prescription by a certified doctor as a part of treatment, including vitamins, minerals and organic substances

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    • Cosmetic Surgery Expenses

    Treatment to change appearance unless it is for reconstruction required for a medically essential treatment or following an accident or burns

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    • Treatment for Self-Inflicted Acts

    Medical expenses incurred as a result of self-harm, as a result of intoxication, illegal actions, hazardous activities, etc.

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    • Deductibles & Co-pays

    Part of the claim will be borne by you if you have opted for deductibles or co-pay

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    • Note

    Please read policy wording for detailed exclusions

    Additional Covers

    What else can you get?
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    • Air Ambulance Cover (Available for SI 5 Lacs & Above)

    Covers expenses incurred for rapid ambulance transportation to the nearest hospital in an airplane or helicopter from the first incident site of illness or accident during policy period

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    • Voluntary Aggregate Deductible

    Covers medical expenses for in-patient hospitalisation beyond the voluntary aggregate deductible limit (INR 50,000/ INR 1,00,000/ INR 2,00,000/ INR 3,00,000) as opted as per policy terms for in-patient hospitalisation treatment

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    • Health Prime Rider

    Coverage for in-person or online doctor consultation, dental wellness, emotional wellness, and diet & nutrition consultations as per the chosen plan

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    • Respect Rider (Senior Care)

    Senior citizens can avail emergency assistance with services such as SOS alert, doctor on call, and 24x7 ambulance service

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    • Room Capping Waiver

    Removes the room type restriction of "up to single private air-conditioned room" for Health Guard Gold and Platinum plans and provides coverage for actual room rent expenses without a limit

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    • More Add-Ons

    Explore more add-ons to enhance coverage

    Benefits You Deserve

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    Wide coverage

    Choose your coverage as per your requirement

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    Wellness Discount

    Stay fit during the policy year and enjoy 12.5% discount on renewal

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    Reinstatement Benefits

    Unlimited reinstatement of the sum insured upto 100% SI after its depletion

    What Are Day Care Procedures?

    Daycare procedures are medically necessary surgeries or treatments that, thanks to modern techniques, finish in under 24 hours, so you’re discharged the same day. Typical examples include cataract removal, chemotherapy and keyhole orthopaedic repairs. By classifying them separately from inpatient admissions, insurers can reimburse bills without insisting on a 24-hour stay, making daycare procedures a vital part of any up-to-date policy.

    Health Insurance Day Care Treatment List

    Category

    Representative Procedures

    Key Notes

    Eye care

    Cataract extraction, tear-duct surgery

    High frequency in seniors

    Oncology

    Cancer chemotherapy, radiation therapy

    Often multiple cycles

    Renal

    Haemodialysis, renal biopsy

    Recurrent sessions possible

    Cardiac

    Coronary angiography, pacemaker check-ups

    Minimally invasive

    ENT

    Septoplasty, tonsillectomy, sinus aspiration

    Common in all ages

    Orthopaedics

    Arthroscopic ligament repair, joint injections

    Sports injuries

    Gastro-hepatic

    Liver biopsy, endoscopic polyp removal

    Day observation only

    Dermatology

    Laser excision of lesions, vitiligo grafting

    Cosmetic & therapeutic

    Paediatrics

    Myringotomy with grommet insertion

    Short-stay anaesthesia

    Urology

    Lithotripsy, cystoscopy

    Stone management

    This daycare treatment list reflects procedures widely accepted by Indian insurers and the IRDAI schedule.

    Eligibility Criteria for Daycare Coverage

    ●        An active health policy with a daycare benefit selected

    ●        The procedure appears on the insurer’s approved daycare treatment disease list

    ●        Undertaken in a registered hospital/day-care centre

    ●        Doctor certifies < 24-hour medical necessity

    At-A-Glance

    Compare Insurance Plans Made for You

    Plans
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    Health Guard Silver

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    Health Guard Gold

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    Health Guard Platinum

    Hospital & Day Care SI INR 1.5/ 2 Lacs INR 3 Lacs to INR 50 Lacs INR 5 Lacs to INR 1 Cr.
    Room Limits Up to 1% of SI per day and ICU at actuals Single private AC room for sum insured of SI 3 Lacs to 7.5 Lacs | Actuals for SI 10 Lacs & above | ICU at Actuals Single private AC room for sum insured of SI 3 Lacs to 7.5 Lacs | Actuals for SI 10 Lacs & above | ICU at Actuals
    Pre- & Post-Hospitalisation Pre: 60 days & Post: 90 days Pre: 60 days & Post: 90 days Pre: 60 days & Post: 90 days
    Organ Donor, AYUSH, Modern Treatments Up to sum insured Up to sum insured Up to sum insured
    Road Ambulance INR 20,000/policy year INR 20,000/policy year INR 20,000/policy year
    Preventive Check-Up 1% of SI (max up to 2,000) once in 3 years 1% of SI (max up to 5,000) once in 3 years 1% of SI (max up to 5,000) once in 2 years
    Maternity & Newborn Care Not covered As per limits specified As per limits specified
    Convalescence Benefit INR 5,000/policy year INR 5,000/policy year for sum insured up to INR 5 lacs | INR 7,500/policy year for sum insured of 7.5 lacs and above INR 5,000/policy year for sum insured up to INR 5 lacs | INR 7,500/policy year for sum insured of 7.5 lacs and above
    Sum Insured Reinstatement 100% of the base sum insured 100% of the base sum insured 100% of the base sum insured
    Wellness Discount Up to 12.5% wellness discount for healthy habits on renewal Up to 12.5% wellness discount for healthy habits on renewal Up to 12.5% wellness discount for healthy habits on renewal
    More Covers See Policy documents for more details

    Types of Procedures Covered

    ●      Ophthalmic: cataract, glaucoma stent, corneal graft

    ●      Cardiovascular: angiography, angioplasty, preparatory scans

    ●      Cancer care: chemotherapy infusions, radio-frequency ablation

    ●      Renal: dialysis, AV-fistula repair, kidney biopsy

    ●      ENT & oral: tonsillectomy, adenoidectomy, nasal polyp removal

    ●      Musculoskeletal: arthroscopy, carpal-tunnel release, tendon repair

    ●      Dermatology & plastic: skin grafts, laser excision, keloid revision

    ●      Gynaecology: laparoscopy for cysts, D&C, hysteroscopy

    ●      Urology: lithotripsy, ureteric stent removal, TURP

    ●      Neurology: trigeminal-nerve rhizotomy, VP-shunt adjustment

    These bullets showcase the breadth of cover most modern plans now provide.

    Day Care vs OPD vs Inpatient Treatment

    Feature

    Day Care

    OPD

    Inpatient

    Hospital stay

    < 24 hrs

    None

    ≥ 24 hrs

    Anaesthesia/theatre

    Often

    Rare

    Yes

    Claim method

    Cashless/reimbursement

    Usually reimbursement

    Cashless/reimbursement

    Typical examples

    Dialysis, cataract

    GP visit, X-ray

    Appendectomy, bypass

    Impact on sum insured

    Deducted

    Usually separate OPD limit

    Deducted

    Pre and Post-Hospitalisation Costs

    Comprehensive plans usually pay medical expenses 30 days before and 60–90 days after a daycare event. This includes specialist consultations, diagnostics, pharmacy bills and follow-up physiotherapy linked to the procedure. Retaining invoices and doctors’ prescriptions is essential, as insurers reimburse only those items directly connected to the treatment episode. Such cover stops minor tests and medicines from eroding household savings while you prepare for—or recover from—a same-day surgery.

    Benefits of Having Daycare Coverage

    ●        Choose advanced procedures without a mandatory 24-hour stay

    ●        18,400+ cashless hospitals with Bajaj General Insurance mean hassle-free admission nationwide

    ●        Avoid proportionate deductions tied to room classes

    ●        Faster recovery at home reduces infection risk

    ●        Makes high-tech care (e.g., laser, endoscopy) affordable

    ●        Counts against main sum insured, so no separate top-up needed

    ●        Enhances policy relevance as medical technology advances

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    How to Choose the Right Daycare Coverage

    ●        Check the insurer’s day care procedures, health insurance schedule—longer lists give better future proofing

    ●        Ensure the sum insured comfortably covers high-cost oncology or cardiac sessions

    ●        Verify cashless network size; Bajaj General Insurance, for example, publishes one of the largest lists in India

    ●        Compare sub-limits on consumables and surgeons’ fees

    ●        Look for add-ons like a recovery benefit or an OPD rider for holistic cover

    ●        Read waiting-period clauses for pre-existing conditions carefully

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    How to File a Claim for Daycare Procedures?

    The process for filing a claim for a daycare procedure is simple. If you require a medical procedure at a moment’s notice, you must safely store your medical bill. You must submit the bill and any other necessary documents to your health insurance provider for reimbursement.

    If you are undergoing a planned daycare procedure, it is advisable to notify your health insurance company first and then proceed with the cashless system of claiming.

    Step-by-Step Guide

    To guide you through your insurance journey.

    How to Buy

    • 1

      Visit Bajaj General website

    • 2

      Enter personal details

    • 3

      Compare health insurance plans

    • 4

      Select suitable coverage

    • 5

      Check discounts & offers

    • 6

      Add optional benefits

    • 7

      Proceed to secure payment

    • 8

      Receive instant policy confirmation

    How to Renew

    • 1

      Login to the app

    • 2

      Enter your current policy details

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      Review and update coverage if required

    • 4

      Check for renewal offers

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      Add or remove riders

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      Confirm details and proceed

    • 7

      Complete renewal payment online

    • 8

      Receive instant confirmation for your policy renewal

    How to Claim

    • 1

      Notify Bajaj General about the claim using app

    • 2

      Submit all the required documents

    • 3

      Choose cashless or reimbursement mode for your claim

    • 4

      Avail treatment and share required bills

    • 5

      Receive claim settlement after approval

    How to Port

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      Check eligibility for porting

    • 2

      Compare new policy benefits

    • 3

      Apply before your current policy expires

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      Provide details of your existing policy

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      Undergo risk assessment by Bajaj General

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      Receive approval from Bajaj General

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      Pay the premium for your new policy

    • 8

      Receive policy documents & coverage details

    Expand Your Coverage Today!

    Respect Rider (Senior Care)

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    Emergency assistance for senior citizens

    Designed specifically for senior citizens

    Starting from

    INR 907 + GST

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    Health Prime Rider

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    Tele, In-Clinic Doctor Consultation and Investigation

    Dental, Nutrition and Emotional Wellness

    Starting from

    INR 298 + GST

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    Non-Medical Expenses

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    Covers non-medical items

    Items not typically covered in standard insurance plans

    Starting from

    8% of Premium

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    Waiver of Room Capping

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    Removes single room type restriction*

    Covers actual room rent expenses without a cap

    Starting from

    2% of Premium

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    FAQ's

    Is Daycare Coverage Automatically Included in Health Insurance Plans?

    Most modern comprehensive policies include day care, but basic or budget covers may not—always read your policy schedule.

    Do Health Insurance Plans Cover Daycare Treatments for Senior Citizens?

    Yes, age is no barrier. However, premiums and pre-policy health checks may differ for seniors.

    What Is Covered Under OPD (Outpatient) Treatment in Health Insurance?

    OPD usually pays for consultations, routine diagnostics, minor dressings and prescribed medicines without hospital admission.

    Does Group Health Insurance Include Daycare Treatment Coverage?

    Most corporate/group policies do, but the procedure list and limits depend on employer negotiations—check your certificate of insurance.

    Are There Any Limits on Claim Amounts for Daycare Treatments?

    Generally, costs are covered up to the remaining sum insured; specific sub-limits are rare but can apply to high-end equipment charges.

    Are COVID-19 Related Procedures Covered as Daycare Treatments?

    Certain rapid tests or monoclonal antibody infusions qualify if done in a registered facility and listed by the insurer.

    What happens if I exceed my sum insured?

    Once the overall limit is exhausted, any additional expenses become payable by you, regardless of room category.

    How do I go about renewing health insurance plans?

    Don’t stress the small things in life! The easiest and quickest way to renew your life insurance policy is by doing it online. Topping up your health cover gives you freedom from worrying about heavy medical expenses.

    How is the health insurance renewal premium calculated?

    We know that reading through the ponderous terms and conditions section of a health insurance policy isn’t always easy. So, here is the quick answer. Your renewal premium is calculated based on your age and coverage. As always, you can put the power of compounding to good use by investing in health insurance as early as possible.

    Can I renew my expired health insurance policy?

    Yes, of course. Life can get really busy and even things as important as renewing your health insurance plan can get side-lined. With Bajaj General, we turn back the clock to give a grace period where you can renew your expired policy. For 30 days from the expiry date, you can still renew your health cover with ease. Now, you can run the race at yo

    Can I renew health insurance online?

    Absolutely! All you have to do to renew your health insurance is click or tap a few times! You can definitely renew health insurance policies online and also buy new policy for your family & friends click here to know more.

    Will I be able to transfer my health insurance policy from another providers?

    Yes, as per IRDAI regulations, insurance portability between providers is allowed. This also includes transfer of benefits like Cumulative Bonus and credits relating to waiting period for pre-existing diseases.

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