What are non-medical expenses in health insurance?

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20 Apr 2023

Understanding the List of Non-Medical Expenses Excluded from Health Insurance Coverage

A health insurance policy is primarily purchased to safeguard your finances in the event of a medical emergency. However, you may have noticed that despite the cashless process, a certain amount must still be paid by you, the policyholder, during a patient's discharge. This is due to the presence of non-medical expenses, which are not covered by your health insurance plans. 

The Insurance Regulatory and Development Authority of India (IRDAI) directs all insurance companies to adhere to its guidelines that exclude some of the non-medical expenses from health insurance plans to prevent insurers from incurring excessive charges. While sometimes, it may seem inequitable to some policyholders, it is a necessary measure to protect insurance companies. 

Before you sign up for a health policy, it is essential to understand all the inclusions and exclusions of a policy. In this article, we will discuss some of the non-medical expenses in health insurance and understand them. 

List of the non-medical expenses’ health insurance:

While items like room rent, doctor’s fees, medicine costs, etc., are settled by the insurance company during hospitalisation, there are certain items that are not covered as per the guidelines of IRDAI for claim settlement. To avoid unpleasant surprises while settling claims, you should be aware of the following non-medical expenses health insurance. 

1. Optional items

Here are certain items that are considered to be optional and are not covered by any health insurance policy-

  • Mineral water

  • Outside food

  • Thermometer

  • Baby food

  • Laundry service

  • Braces or belts

  • Nebuliser kit

2. Items that are to be subsumed into room charges

Although room charges are covered under a health policy, certain items used inside the room aren’t covered. Those include-

  • Toothpaste and toothbrush

  • Hand Wash and disinfectant lotions

  • Slippers

  • Gown

  • Comb and caps

  • Tissue paper

  • Housekeeping charges

  • Pulse oximeter charges

1. Items that are to be subsumed into procedure charges

These are some of the items that are used during surgeries or other procedures and are not covered by a health insurance policy-

  • Surgical blades

  • Cotton & bandages

  • Disposable razors

  • Arthroscopy and Endoscopy instrument charges

  • Apron

  • Eye pad

  • Surgical drill

2. Items that are to be subsumed into costs of treatment

Health professionals use certain items for treatment that are not covered under a health insurance policy. Such items include-

  • Registration or admission charges

  • Urine container

  • Antiseptic mouthwash

  • Blood reservation cost

  • Spirit, disinfectant, and hydrogen peroxide

  • A nutritionist or dietician charges

  • Vaccination charges

  • Infusion pump charges

3. Other non-payable medical costs

Let’s look at some more non-payable medical expenses-

  • Needles, syringes, and injections

  • Medicine box

  • Paper gloves

  • Washing charges

  • Digestion gels

  • Barber charges

  • Referral doctor’s fees

Conclusion

The health insurance industry typically excludes certain non-medical expenses, as outlined in the IRDAI guidelines for claim settlement. It's important to review this list before purchasing a plan, which can be found on your insurer's website. Familiarising yourself with the inclusions and exclusions of your health insurance policy is crucial to avoid unexpected costs in the event of an emergency. To fully understand what is not covered in your health insurance plan and avoid unpleasant surprises down the road, always read the terms and conditions in your policy document carefully.


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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.