What are Non-Medical Expenses in Health Insurance?

Posted on: May 13, 2022 | | Written by:

What are Non-Medical Expenses in Health Insurance?

Published on May 13, 2022. EST READ TIME: 4 minutes

The chief reason behind buying health insurance plans is to protect our finances during medical emergencies. But you might have seen that during the discharge of a patient, we are still asked to pay a certain amount even if the whole process was cashless. That’s because there are items that are not covered by health insurance plans. These are called non-medical expenses and the Insurance Regulatory and Development Authority of India (IRDAI) has allowed insurance providers to exclude them. While it may look unfair to you as the policyholder, the items are excluded to save insurers from being charged excessively.

What are non-medical expenses in health insurance?

Standard individual health insurance plan covers your medical expenses during hospitalization. They protect you financially and help you to get the best medical treatment possible. However, there are some items which are not covered by insurance during treatment or hospitalization. To restrict the misuse of health insurance, the IRDAI has excluded the expenses of certain items that you may incur during hospitalization. These expenses are called non-medical expenses in health insurance plans and it is not mandatory for insurance companies to compensate the same during claim settlement.

List of non-medical expenses in health insurance as per IRDAI guidelines

As per the IRDAI guidelines for health claim settlement, there are some non-medical expenses which you should be aware of to avoid surprises at the time of settling claims. These are:

1. Non-medical expenses in room charges:

These include toothpaste and toothbrush, hand wash, tissue papers, gown, slippers, comb, caps, disinfectant lotions, blankets, housekeeping charges, pulse oximeter charges.

2. Non-medical expenses in the treatment cost:

During hospitalization, there are some expenses as part of treatment which cannot be claimed, such as admission/registration charges, blood reservation charges, antiseptic mouthwash, dietician & nutrition planning charges, spirit, disinfectant, hydrogen peroxide, urine container, vaccination charges, infusion pump charges.

3. Non-medical expenses in procedure cost:

In procedure cost, the non-medical expenses are surgical blades, instruments, gauze, cotton & bandages, apron, arthroscopy and endoscopy instrument charges, disposable razors, eye pad, etc. These expenses occur mainly during surgeries and treatment for pro-longed illnesses covered under critical illness cover.

4. Other non-payable medical expenses:

Medicine box, needles, syringes, injections, washing charges, digestion gels, paper gloves, barber charges, referral doctor’s charges are some of the non-payable medical expenses.

Knowing more about non-medical expenses in health insurance before claims

These non-medical expenses in health insurance are excluded are followed across the health insurance industry. The IRDAI guidelines for health insurance claim settlement has given a list of non-medical expenses and it is available on the insurer’s website. Be aware of the list before you buy a health insurance plan. You should know the inclusions and exclusions of the mediclaim policy to avoid any surprises in the future, especially at the time of emergencies.

Do read the terms and conditions mentioned in the policy document to understand what is not covered in your health insurance plan to avoid being shocked later on.

Frequently asked questions

Some of the common questions about non-medical expenses in health insurance are as follows:

What do you mean by non-reimbursable medical expenses?

Non- medical expenses are also called non-reimbursable expenses, which are not covered by the health insurance.

Can non-medical expenses be covered in my health insurance policy?

Non-medical expenses are offered as add-ons for an additional premium by many insurance companies. If you opt to buy the non-medical expenses add-on cover, it increases the overall health insurance coverage.

Is diabetic footwear considered a medical expense in health insurance?

No, diabetic footwear is considered a non-medical expense in health insurance.

Will pre and post-hospitalization expenses be considered non-medical expenses in health insurance?

As per the policy terms and conditions, some pre and post-hospitalization expenses will be considered as medical expenses and covered by the health insurance policy. It depends on the type of health insurance plan you buy.

Conclusion

The non-medical expenses are generally affordable and can be paid from your own pocket. However, it is vital that you know the exclusions of your health insurance plans and avoid claiming the non-medical items for a smooth settlement. It is also wise to make a comparison of different plans offered by different insurers and choose the one that provides maximum coverage.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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