List of Different Types of Non-Medical Expenses in Health Insurance

When a patient is hospitalised either for surgery or treatment, a lot of things are needed. Of these, some things are deemed necessary for medical treatment and are covered by the health insurance plan. Others are clubbed together as a list of non medical items as per IRDAI. These are costs that are not covered by the policy. The IRDAI created this list to ensure that medical insurance is not misused by people or hospitals.

IRDAI has created a list of different types of non payable items in mediclaim that are excluded from the coverage of a health insurance plan. The list is followed by all insurers and is standard across the health insurance industry.

This means that all these non-medical expenses will have to be borne by the policyholder. The categories are as follows:

Treatment Costs: This list includes items that are used as a part of the treatment.

Hospital Room Charges: While the policy includes the hospital room cost, the following items are not covered under a health insurance plan.

Procedure Costs: If there is a surgical procedure, then the policy covers all costs associated with the surgery except for the following items.

Others (including optional costs)

Here is the list of non payable items in health insurance:

As per the guidelines set by the IRDAI, the standard health insurance plan does not cover these costs. However, to help make things easier for policyholders, many insurers offer a rider/add-on cover to manage the costs of most of these consumables.

When you buy health insurance online, you can look at the add-ons offered and select the Consumables Benefit cover. By paying a small additional premium, you can get rid of the hassle of paying for consumables associated with the treatment. However, make sure to go through the inclusions and exclusions of the add-on before buying.

It is important to remember that while there are certain guidelines for regulating health insurance policies, every insurer offers a unique package to policyholders. Therefore, before making the purchase, it is important to read the fine print and ask questions.

You should know everything about the inclusions and exclusions of the policy, limits (if any), and any other factor that can impact the claim.

With Tata AIG, you can enjoy various benefits of health insurance, like quick claim settlement, easy online policy renewals, exhaustive list of network hospitals, and several health insurance add-ons, including the consumables benefits.

What are the non-medical expenses?

In health insurance, non-medical expenses are costs incurred on a range of items during hospitalisation that are not covered under the policy. The IRDAI creates a list of all items that constitute non-medical expenses and every insurer refers to it while processing claims. Hence, these are items that the policyholder needs to pay for.

Which type of expenses will be covered under health insurance?

While the list of inclusion can vary from one insurer to another, generally, a health insurance policy covers the following expenses:

In-patient treatment costs

Pre-hospitalisation expenses

Post-hospitalisation expenses

Day Care Procedures

Medical and surgical expenses of the organ donor

Domiciliary Treatment

AYUSH treatments

Ambulance expenses

Health checkup costs

Do health insurance policies in India offer riders or add-ons to cover non-medical expenses?

Yes, many insurance companies offer riders to help you manage the above mentioned non-medical expenses.

The riders may not cover the entire list but still offer respite from otherwise having to manage a sizable portion of the overall bill. While buying or renewing your health insurance policy, talk to the insurer about this add-on cover.

How can I best manage and budget for non-medical expenses when seeking healthcare treatment?

While one option is to buy a rider that offers coverage for these expenses, if you do not want to do that, then you need to start budgeting for these costs.

There is no benchmark available on how much these expenses add up to. However, you can talk to the hospital administrative staff to get an idea.

Are non-medical expenses consistent across all health insurance policies, or do they vary among insurers?

Since the list of non-medical expenses is created by the IRDAI, it is standard across all policies. This means that no insurer will offer coverage for the expenses specified under the list. However, they offer riders at an additional cost to help people get these expenses included in the scope of the policy.