Non-Medical Expenses in Health Insurance

What Are Non-Medical Expenses in Health Insurance?

Non-medical expenses are costs incurred on items used during hospitalization that are not directly related to medical treatment. Examples include scissors, clothes, urine containers, and laundry attendant charges. As per IRDAI guidelines, these items are excluded from mediclaim insurance coverage. However, some insurance companies offer coverage for these items as an optional cover or through health insurance riders.

When you have comprehensive health insurance, you feel safe and secure knowing that your family is financially protected and will get the best healthcare facilities in case of medical emergencies. However, health insurance companies follow a strict claim process as directed by the Insurance Regulatory and Development Authority of India (IRDAI).

To prevent misuse, IRDAI has excluded these non-medical expenses. This article lists non-medical expenses under health insurance, also known as policy exclusions.

Expert Insights

Hidden within every health insurance premium lies a complex web of costs, a significant portion of which are allocated not to doctor’s visits or prescriptions, but to a category often overlooked: Non-Medical Expenses.

List of Non-Medical Expenses in Health Insurance as per IRDAI Guidelines

According to IRDAI guidelines, certain optional items used during treatment or hospitalization are not considered medical expenses.

Here is a list of non-payable items in health insurance:

• Food (other than provided by the hospital)
• Carry bags
• Baby food
• Nebuliser kit
• Laundry
• Attendant charges
• Mineral water
• Thermometer
• Beauty services
• Belts/braces

Non-Medical Expenses in Room Charges

Below is the list of non-medical expenses typically excluded from room charges during hospitalization:

• Hand wash
• Housekeeping charges
• Tissue paper
• Comb, caps
• Slippers
• Toothpaste and toothbrush
• Pulse oximeter charges
• Buds
• Gown
• Foot cover
• Cold pack/hot pack

Non-Medical Expenses in Treatment Costs

Certain items used by healthcare professionals during patient hospitalization are considered non-medical costs. The following are examples:

• Registration/admission charges
• Spirit, disinfectant, hydrogen peroxide
• Nutritionist or dietician charges
• Infusion pump charges
• Urine container
• Blood reservation cost
• Vaccination cost
• Diabetic footwear
• Antiseptic mouthwash
• HIV kit

Non-Medical Expenses in Procedure Costs

The items listed below are considered non-medical expenses in medical procedure costs:

• Hair removal cream
• Surgical blades
• Disposable razors
• Bandages, cotton
• Surgical drill
• Harmon scalpel blades
• Apron
• Arthroscopy and Endoscopy instrument charges
• Eye pad
• Gauze blades

Other Non-Payable Expenses

Below is a list of additional non-medical expenses in health insurance:

• Barber charges
• Syringes, needles, sterilized injections
• Washing charges
• Referral doctor’s fees
• Digestion gels
• Paper gloves
• Medicine box

List of Companies Providing Non-Medical Expenses Riders

What If I Want Non-Medical Expenses Covered?

These expenses can significantly increase the medical bill and cannot be ignored. If you want to cover these costs, consider the health plans mentioned above. While standard health insurance policies generally do not cover non-medical expenses, many providers offer riders or include them as built-in benefits. Here are some options to explore:

• Check with your insurer: Contact your insurance provider to inquire about any available riders or add-ons that cover non-medical expenses. They can provide specific details on coverage limits, exclusions, and additional costs.
• Consider specialized plans: Some insurance companies offer specialized health plans that include coverage for certain non-medical expenses. These plans may have higher premiums but provide broader coverage.
• Explore alternative options: Depending on the specific non-medical expenses you’re interested in covering, you might consider alternative options like personal accident insurance, critical illness insurance, or disability insurance.

Always check your health insurance policy documents carefully and understand all terms and conditions before making a decision.

Key Things to Remember About Non-Medical Expenses in Health Insurance

• Non-medical expenses in health insurance are items essential for healthcare facilities but not directly related to medical treatment.
• Policyholders can opt for available riders to cover these costs. Always read policy documents carefully to understand which non-medical expenses are covered and which are excluded.
• IRDAI provides a standard list of non-payable items to help policyholders understand what is typically excluded from their health plans.
• Non-payable items in health insurance are categorized into five main areas: optional items, non-medical expenses in treatments, non-medical expenses in room charges, non-medical expenses in procedure costs, and other non-payable expenses.
• A separate list of non-medical expenses is typically not covered under room rent by the insurer. These include items like tissues, handwash, slippers, gowns, and dental kits. Remember that your room rent will not cover these items.
• Generally, non-payable items are not covered across the health insurance industry unless a specific rider is opted for.

How to Understand Non-Medical Expenses Before Making a Claim?

Non-medical expenses are commonly excluded from health insurance policies. IRDAI has established guidelines for health insurance claim settlement and provides a list of non-medical expenses, which is usually available on the insurer’s website. It is important to be aware of this list before buying any plan. Understanding the inclusions and exclusions of your mediclaim policy can help avoid surprises, especially during emergencies.

Always read the terms and conditions in your policy document to understand all exclusions and inclusions, preventing future discrepancies.

Conclusion

To make an informed decision, you must understand your health insurance coverage. Review your health insurance policy. By carefully reviewing your policy documents and seeking clarification from your insurer when needed, you can ensure that you and your loved ones are adequately protected in times of medical need.

When purchasing health insurance, compare plans from different insurers to understand their exclusions and select the best plan for your needs. Contact us today for a free consultation and let our expert advisors guide you in selecting the right health insurance plan that aligns with your specific needs and budget.