IRDAI Defines These Items as Non-medical Expenses in Your Health Insurance Policy

Having a well-planned health insurance policy can have a significant and positive impact on one’s overall financial and physical well-being. A health insurance plan with comprehensive coverage can help you and your loved ones handle medical emergencies without any financial worries. However, when it comes to covering medical treatments, there are some expenses that may not be covered by even the most comprehensive health insurance plans. This is mainly because these expenses are defined as “non-medical expenses” by the Insurance Regulatory and Development Authority of India (IRDAI). What comes under these “non-medical expenses” and how does their exclusion affect your health insurance policy experience? Let’s learn more about the same.

What are non-medical expenses and why are they excluded?

Non-medical expenses are usually those expenses that may be a part of your hospitalisation or treatment procedure but are not necessarily included in health insurance coverage due to various reasons. Many of these expenses may not be directly related to your treatment; however, they may be a part of the services that the hospital provides to its patients. For instance, some hospitals provide toiletries, personal care items, convenience items, or even cosmetics for the patient’s comfort. The expenses for these items are usually excluded from health insurance coverage. The exclusion of these items may also result from the fact that their coverage may lead to misuse of medical insurance policies. It is to be noted that the exclusion for non-medical expenses only applies to indemnity policies, where the compensation received depends on the hospital bill. This is not applicable to benefit-based policies where the pay-out is pre-fixed and unaffected by any treatment costs.

List of non-medical expenses excluded by IRDAI 

For your better understanding, the excluded non-medical expenses have been classified into different categories. Let’s go through them:

1. Non-medical expenses incurred during treatment 

The following expenses may be incurred during the patient’s treatment, depending on their health condition:

1. Charges for admission/registration in the hospital
2. Spirit, disinfectant, and hydrogen peroxide
3. Infusion pump charges
4. Vaccination cost
5. Antiseptic mouthwash
6. Diabetic footwear
7. Charges incurred for nutritionist or dietician’s services
8. Urine bags
9. Blood reservation costs
10. HIV kits

2. Non-medical expenses incurred as a part of room charges 

As a part of your room services, the following charges may be incurred:

1. Housekeeping charges
2. Hospital gowns and foot covers
3. Pulse oximeter charges
4. Toothpaste/ toothbrushes
5. Personal care items, such as combs, caps, slippers, buds, and so on
6. Tissue paper
7. Handwash
8. Cold packs/ hot packs

3. Non-medical expenses incurred during hospital procedures 

If you are undergoing surgery or any other procedure, your hospital bill may include the following non-medical expenses:

1. Bandages, cotton
2. Apron
3. Surgical blades
4. Gauze blades
5. Harmon scalpel blades
6. Eye pads
7. Disposable razors
8. Surgical drill
9. Hair removal cream
10. Arthroscopy and endoscopy instrument charges

4. Non-medical optional expenses 

Some optional items or services provided during the hospital stay which are optional for treatment, and are not covered under medical insurance, include:

1. Baby food
2. Food (except for what is provided by the hospital)
3. Mineral water
4. Laundry charges
5. Thermometer
6. Nebuliser kit
7. Beauty services
8. Belts/ braces
9. Carry bags

5. Other items and services under non-medical expenses 

Some other items and services that come under the non-medical expense exclusions list include:

1. Paper gloves
2. Digestion gels
3. Washing charges
4. Medicine box
5. Referral doctor charges
6. Syringes, needles, injections
7. Barber charges

An important note:

Sometimes, small items that may not be covered under a regular medical insurance indemnity policy may be covered under the consumables cover add-on. This add-on can supplement your health insurance coverage very well, especially if you are likely to be hospitalised for a long period. * Regardless, there may be exclusions even within the consumables cover add-on. Hence, you should get to know the items covered under the add-on before opting for one.

Significance of health insurance coverage 

1. One should not form a negative outlook on health insurance by considering these excluded expenses only. Health insurance coverage can be quite extensive, including but not limited to the following :
2. Ambulance services
3. Pre- and post-hospitalisation charges
4. Day-care procedures
5. Organ donor expenses
6. Ayurvedic or homoeopathic treatment
7. Maternity and new-born coverage
8. Preventive health check-ups, and so on.

The coverage usually differs depending on the insurance company and plan you select.

1. One can increase their additional financial protection by opting for extra coverage such as vector-borne illnesses coverage, global coverage, and so on. *
2. Health insurance can help you achieve better peace of mind. It ensures that you and your loved ones can access high-quality treatment with no financial woes in mind. This allows you to focus on the important things during times of medical urgency - rest, recovery, and familial support. *
3. Furthermore, health insurance also provides tax benefits up to Rs 25,000 for individuals under 60 years of age and up to Rs 50,000 for those over 60 years of age, under Section 80D of the Income Tax Act of 1961. Thus, paying health insurance premiums can also help you save on taxes. Note that tax benefits are subject to change in prevalent tax laws. *

* Standard T&C apply.  Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.