When you have the right comprehensive health insurance, you feel safe and secure knowing that your family is financially protected knowing that your family will get the best healthcare facilities in case of medical emergencies. But, health insurance companies follow a strict claim process as directed by the Insurance Regulatory and Development Authority of India (IRDAI).
To prevent the misuse of health insurance, the IRDAI has excluded some medical expenses, known as non-medical expenses in health insurance. We've listed the non-medical expenses under health insurance in this below article also known as insurance policy's exclusions.
Health Insurance covers the medical expenses of planned and unplanned hospitalization. However, some medical expenses are excluded from the insurance coverage and these expenses are called non-medical expenses.
These costs cannot be ignored because they frequently result in significant increases in medical costs. Many health insurance providers include riders or built-in costs for non-medical expenses in the plan. Here are the names of the rider for Non- Medical expenses.
Company | Plan | Non-Medical Items |
Aditya Birla | Aditya Birla - Diamond | Optional (Through Future Secure Rider) |
Aditya Birla | Aditya Birla - Enhance | Optional (Through Future Secure Rider) |
Aditya Birla | Aditya Birla - Essential | Optional (Through Future Secure Rider) |
Care | Care Advantage | Optional (Through Care Shield Rider) |
Care | Care Classic | Not Available |
Care | Care Freedom | Optional (Through Care Shield Rider) |
Care | Care Heart | Optional (Through Care Shield Rider) |
Care | Care Plan | Optional (Through Care Shield Rider) |
Care | Care Plus | Not Available |
Care | Care Senior | Optional (Through Care Shield Rider) |
Care | Care Supreme | Not Available |
HDFC | HDFC my health Suraksha | Not Available |
HDFC | HDFC Optima restore | Not Available |
HDFC | HDFC Optima Secure | Covered upto SI |
ManipalCigna | ManipalCigna - Lifetime | Optional (Through Health 360 - Shield Rider) |
ManipalCigna | ManipalCigna - Prime Active | Optional (Through Non-Medical Items Rider) |
ManipalCigna | ManipalCigna - Prime Advantage | Optional (Through Non-Medical Items Rider) |
ManipalCigna | ManipalCigna - Prime Protect | Optional (Through Non-Medical Items Rider) |
ManipalCigna | ManipalCigna - Pro Health Plus | Optional (Through Health 360 - Shield Rider) |
ManipalCigna | ManipalCigna - Pro Health Preferred | Optional (Through Health 360 - Shield Rider) |
ManipalCigna | ManipalCigna - Pro Health Protect | Optional (Through Health 360 - Shield Rider) |
Niva | Niva - Premia | Not Available |
Niva | Niva bupa health companion | Optional (Through Safeguard Rider) |
Niva | Niva bupa Reassure | Optional (Through Safeguard Rider) |
SBI | SBI Arogya Plus | Not Available |
SBI | SBi Arogya Sanjeevani | Not Available |
Star | Family health optima | Not Available |
Star | Mediclassic Individual (Basic) | Not Available |
Star | Mediclassic Individual (Gold) | Not Available |
Star | Star Arogya Sanjeevani | Not Available |
Star | Star Assure | Covered upto SI |
Star | Star Comprehensive | Not Available |
Star | Star senior citizen red carpet | Not Available |
Star | Star Women Care | Covered upto SI |
Star | Star youngster | Not Available |
According to IRDAI guidelines, some optional medical items used during treatment or hospitalization are not considered medical expenses. Let us have a look at the list of non-payable items in health insurance:
These non-medical expenses in health insurance are commonly excluded from the policies. IRDAI has established guidelines for health insurance claim settlement and has given a list of non-medical expenses which is available on the insurer’s website. It is important to be aware of the list before buying any plan. You should understand the inclusions and exclusions of the mediclaim policy to avoid any surprises in the future, especially in times of emergencies.
Do read the terms and conditions mentioned in the policy document to understand all the exclusions and inclusions of the health insurance plan, in order to avoid any future discrepancies.
Below-mentioned is the list of non-medical expenses in the room charges during hospitalization.
Certain items are used by healthcare professionals to treat patients while they are hospitalized. The following are the non-medical costs incurred during treatment.
The items listed below are considered non-medical expenses in procedural costs.
Below-mentioned is the list of additional non-medical expenses in health insurance.
The above mentioned are the non-medical expenses incurred during hospitalization and treatment, and they are very expensive. These are non-admissible costs that aren't covered under any health insuranceplan. Sometimes, people are unaware of such non-medical expenses that they have to bear these expenses on their own. As a result, it's always a good idea to read the terms and conditions of a health plan before choosing it.
When purchasing health insurance, it is a good idea to compare plans from different insurers to understand the exclusions and select the best health insurance plan. Also, read the fine print of the policy to make an informed buying choice.
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Naval Goel is the Founder and CEO of PolicyX.com (IRDA- Approved Insurance Comparison Website). He is a CFA charter holder (USA) and FRM (GARP). He holds an MBA from IIFT, Delhi, and is also an Associate from the Insurance Institute of India. Naval is an avid investor and entrepreneur who has a deep understanding of the Indian equity market and insurance sector. He has been investing for more than 10 years now and is a CFA charter holder.
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