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200 Non Payable Items/Prescriptions in Health Insurance

Health Insurance Non Payable Items

List of Expenses Generally Excluded (‘Non-admissible Expenses’) in Hospitalisation Policy

GUIDELINES ON STANDARDISATION IN HEALTH INSURANCE – IRDA CIRCULAR No IRDA/HLT/CIR/036/02/2013 DATED 20.02.2013

No.

Items

Suggestions

1

Hair Removing Cream

Not Payable

2

Baby Charges (unless specified/indicated)

Not Payable

3

Baby Food

Not Payable

4

Baby Utilites Charges

Not Payable

5

Baby Set

Not Payable

6

Baby Bottles

Not Payable

7

Brush

Not Payable

8

Cosy Towel

Not Payable

9

Hand Wash

Not Payable

10

Moisturiser Paste Brush

Not Payable

11

Powder

Not Payable

12

Razor

Payable

13

Shoe Cover

Not Payable

14

Beauty Services

Not Payable

15

Belts/ Braces

Essential and Should be Paid at least Specifically for Cases who have undergone surgery of

Thoracic or Lumbar Spine.

16

Buds

Not Payable

17

Barber Charges

Not Payable

18

Caps

Not Payable

19

Cold Pack/Hot Pack

Not Payable

20

Carry Bags

Not Payable

21

Cradle Charges

Not Payable

22

Comb

Not Payable

23

Disposable Razor Charges ( For Site Preparations)

Payable

24

Eau-De-Cologne / Room Freshners

Not Payable

25

Eye Pad

Not Payable

26

Eye Sheild

Not Payable

27

Email / Internet Charges

Not Payable

28

Food Charges (other than Patient’s Diet Provided by Hospital)

Not Payable

29

Foot Cover

Not Payable

30

Gown

Not Payable

31

Leggings

Essential in Bariatric and Varicose Vein Surgery and may be considered for at least these

conditions where Surgery itself is Payable.

32

Laundry Charges

Not Payable

ANNEXURE IV

List of Expenses Generally Excluded (‘

Non-admissible Expenses

‘) in Hospitalisation Policy

GUIDELINES ON STANDARDISATION IN HEALTH INSURANCE – IRDA CIRCULAR No IRDA/HLT/CIR/036/02/2013 DATED 20.02.2013

Toiletries/ Cosmetics/ Personal Comfort or Convenience Items

33

Mineral Water

Not Payable

34

Oil Charges

Not Payable

35

Sanitary Pad

Not Payable

36

Slippers

Not Payable

37

Telephone Charges

Not Payable

38

Tissue Paper

Not Payable

39

Tooth Paste

Not Payable

40

Tooth Brush

Not Payable

41

Guest Services

Not Payable

42

Bed Pan

Not Payable

43

Bed Under Pad Charges

Not Payable

44

Camera Cover

Not Payable

45

Cliniplast

Not Payable

46

Crepe Bandage

Not Payable/ Payable by the Patient

47

Curapore

Not Payable

48

Diaper Of Any Type

Not Payable

49

DVD, CD Charges

Not Payable ( However if CD is specifically sought by Insurer/TPA then Payable)

50

Eyelet Collar

Not Payable

51

Face Mask

Not Payable

52

Flexi Mask

Not Payable

53

Gause Soft

Not Payable

54

Gauze

Not Payable

55

Hand Holder

Not Payable

56

Hansaplast/ Adhesive Bandages

Not Payable

57

Infant Food

Not Payable

58

Slings

Reasonable costs for one sling in case of Upper Arm Fractures may be considered

B

59

Weight Control Programs/ Supplies/ Services

Exclusion in Policy unless otherwise specified

60

Cost Of Spectacles/ Contact Lenses/ Hearing Aids Etc.,

Exclusion in Policy unless otherwise specified

61

Dental Treatment Expenses that do not require Hospitalisation

Exclusion in Policy unless otherwise specified

62

Hormone Replacement Therapy

Exclusion in Policy unless otherwise specified

63

Home Visit Charges

Exclusion in Policy unless otherwise specified

64

Infertility/ Subfertility/ Assisted Conception Procedure

Exclusion in Policy unless otherwise specified

65

Obesity (including Morbid Obesity) Treatment if Excluded in Policy

Exclusion in Policy unless otherwise specified

66

Psychiatric & Psychosomatic Disorders

Exclusion in Policy unless otherwise specified

67

Corrective Surgery for Refractive Error

Exclusion in Policy unless otherwise specified

68

Treatment of Sexually Transmitted Diseases

Exclusion in Policy unless otherwise specified

69

Donor Screening Charges

Exclusion in Policy unless otherwise specified

70

Admission/Registration Charges

Exclusion in Policy unless otherwise specified

Items Specifically Excluded in Policies

71

Hospitalisation for Evaluation/ Diagnostic Purpose

Exclusion in Policy unless otherwise specified

72

Expenses for Investigation/ Treatment irrelevant to the Disease for which

admitted or diagnosed

Exclusion in Policy not payable unless otherwise specified

73

Any Expenses when the Patient is diagnosed with Retro Virus + or suffering

from /HIV/ Aids etc is detected/ directly or indirectly

Not Payable as per HIV/ AIDS Exclusion

74

Stem Cell Implantation/ Surgery & Storage

Not Payable except Bone Marrow Transplantation where covered by Policy

C

75

Ward and Theatre Booking Charges

Payable Under OT Charges, Not Payable Separately

76

Arthroscopy & Endoscopy Instruments

Rental Charged By The Hospital Payable. Purchase of Instruments Not Payable.

77

Microscope Cover

Payable Under OT Charges, Not Payable Separately

78

Surgical Blades,Harmonic Scalpel, Shaver

Payable Under OT Charges, Not Payable Separately

79

Surgical Drill

Payable Under OT Charges, Not Payable Separately

80

Eye Kit

Payable Under OT Charges, Not Payable Separately

81

Eye Drape

Payable Under OT Charges, Not Payable Separately

82

X-Ray Film

Payable Under Radiology Charges, Not as Consumable

83

Sputum Cup

Payable Under Investigation Charges, Not as Consumable

84

Boyles Apparatus Charges

Part Of Ot Charges, Not Seperately

85

Blood Grouping and Cross Matching of Donors Samples

Part Of Cost Of Blood, Not Payable

86

Antiseptic & Disinfectant Lotions

Not Payable-Part of Dressing Charges

87

Band Aids, Bandages, Sterile Injections, Needles, Syringes

Not Payable – Part of Dressing Charges

88

Cotton

Not Payable-Part of Dressing Charges

89

Cotton Bandage

Not Payable-Part of Dressing Charges

90

Micropore/ Surgical Tape

Not Payable-payable by the Patient when Prescribed, otherwise included as Dressing

Charges

91

Blade

Not Payable

92

Apron

Not Payable -Part of Hospital Services/Disposable Linen to be Part of OT/ ICU Charges

93

Torniquet

Not Payable (service is charged by Hospitals, Consumables cannot be separately charged)

94

Orthobundle, Gynaec Bundle

Part of Dressing Charges

95

Urine Container

Not Payable

D

96

Luxury Tax

Policy Exclusion – Not Payable.

If there is no Policy Exclusion, then Actual Tax Levied by

Government is Payable – Part of Room Charge for Sub Limits

97

HVAC

Part of Room Charge Not Payable Separately

98

House Keeping Charges

Part of Room Charge Not Payable Separately

99

Service Charges where Nursing Charge also charged

Part of Room Charge Not Payable Separately

100

Television & Air Conditioner Charges

Payable Under Room Charges Not if separately levied

101

Surcharges

Part of Room Charge Not Payable Separately

Elements of Room Charge

Items Which form Part of Hospital Services where Separate Consumables are not Payable but the Service is

102

Attendant Charges

Not Payable – Part of Room Charges

103

IM/ IV Injection Charges

Part of Nursing Charges, Not Payable

104

Clean Sheet

Part of Laundry/housekeeping Not Payable Separately

105

Extra Diet of Patient(other than that which forms part of Bed Charge)

Not Payable

. Patient Diet Provided by Hospital is Payable

106

Blanket/Warmer Blanket

Not Payable- Part of Room Charges

E

107

Admission Kit

Not Payable

108

Birth Certificate

Not Payable

109

Blood Reservation Charges and Ante Natal Booking Charges

Not Payable

110

Certificate Charges

Not Payable

111

Courier Charges

Not Payable

112

Convenyance Charges

Not Payable

113

Diabetic Chart Charges

Not Payable

114

Documentation Charges / Administrative Expenses

Not Payable

115

Discharge Procedure Charges

Not Payable

116

Daily Chart Charges

Not Payable

117

Entrance Pass / Visitors Pass Charges

Not Payable

118

Expenses Related to Prescription on Discharge

To be Claimed by Patient under Post -Hospitalisation where admissible

119

File Opening Charges

Not Payable

120

Incidental Expenses / Misc. Charges (not Explained)

Not Payable

121

Medical Certificate

Not Payable

122

Maintainance Charges

Not Payable

123

Medical Records

Not Payable

124

Preparation Charges

Not Payable

125

Photocopies Charges

Not Payable

126

Patient Identification Band / Name Tag

Not Payable

127

Washing Charges

Not Payable

128

Medicine Box

Not Payable

129

Mortuary Charges

Payable Upto 24 Hrs, Shifting Charges Not Payable

130

Medico Legal Case Charges (MLC Charges)

Not Payable

F

131

Walking Aids Charges

Not Payable

132

Bipap Machine

Not Payable

133

Commode

Not Payable

134

CPAP/ CPAD Equipments Device

Not Payable

135

Infusion Pump – Cost

Not Payable

136

Oxygen Cylinder (for Usage outside the Hospital)

Not Payable

137

Pulseoxymeter Charges Device

Not Payable

138

Spacer

Not Payable

Administrative or Non-medical Charges

External Durable Devices

139

Spirometre

Not Payable

140

SPO2 Probe

Not Payable

141

Nebulizer Kit

Not Payable

142

Steam Inhaler

Not Payable

143

Armsling

Not Payable

144

Thermometer

Not Payable (paid By Patient)

145

Cervical Collar

Not Payable

146

Splint

Not Payable

147

Diabetic Foot Wear

Not Payable

148

Knee Braces ( Long/ Short/ Hinged)

Not Payable

149

Knee Immobilizer/Shoulder Immobilizer

Not Payable

150

Lumbo Sacral Belt

Essential and should be paid at least specifically for cases who have undergone Surgery of

Lumbar Spine

151

Nimbus Bed or Water or Air Bed Charges

Payable for any ICU Patient requiring more than 3 Days in ICU; All Patients with Paraplegia/

Quadriplegia for any reason and at Reasonable Cost of approximately Rs 200/Day

152

Ambulance Collar

Not Payable

153

Ambulance Equipment

Not Payable

154

Microsheild

Not Payable

155

Abdominal Binder

Essential and should be Paid at least in Post Surgery Patients of Major Abdominal Surgery

Including TAH, LSCS, Incisional Hernia Repair, Exploratory Laparotomy for Intestinal

Obstruction, Liver Transplant Etc.

G

156

Betadine \ Hydrogen Peroxide\spirit\ Disinfectants Etc

May be Payable when prescribed for Patient, Not Payable for Hospital use in OT or Ward or

for dressings ward or for dressings

157

Private Nurses Charges- Special Nursing Charges

Post Hospitalization Nursing Charges Not Payable

158

Nutrition Planning Charges – Dietician Charges- Diet Charges

Patient Diet provided by Hospital is Payable

159

Sugar Free Tablets

Payable -Sugar Free variants of admissable medicines are not Excluded

160

Cream Powder Lotion (Toileteries are Not Payable, only Prescribed Medical

Pharmaceuticals Payable)

Payable when Prescribed

161

Digene Gel

Payable when Prescribed

162

ECG Electrodes

Upto 5 Electrodes are Required for every case visiting OT or ICU. For longer stay in ICU,

may Require a Change and at least one set every second day must be Payable.

163

Gloves

Sterilized Gloves Payable / Unsterilized Gloves not payable

164

HIV Kit

Payable – Pre-Operative Screening

165

Listerine/ Antiseptic Mouthwash

Payable When Prescribed

166

Lozenges

Payable When Prescribed

167

Mouth Paint

Payable When Prescribed

Items Payable If Supported By A Prescription

168

Nebulisation Kit

If used during Hospitalization is Payable Reasonably

169

Novarapid

Payable When Prescribed

170

Volini Gel/ Analgesic Gel

Payable When Prescribed

171

Zytee Gel

Payable When Prescribed

172

Vaccination Charges

Routine Vaccination Not Payable / Post Bite Vaccination Payable

H

173

AHD

Not Payable – Part of Hospital’s Internal Cost

174

Alcohol Swabes

Not Payable – Part of Hospital’s Internal Cost

175

Scrub Solution/ Sterillium

Not Payable – Part of Hospital’s Internal Cost

I

176

Vaccine Charges for Baby

Not Payable

177

Aesthetic Treatment / Surgery

Not Payable

178

TPA Charges

Not Payable

179

Visco Belt Charges

Not Payable

180

Any Kit with no details mentioned [Delivery Kit, Orthokit, Recovery Kit, Etc]

Not Payable

181

Examination Gloves

Not Payable

182

Kidney Tray

Not Payable

183

Mask

Not Payable

184

Ounce Glass

Not Payable

185

Outstation Consultant’s/ Surgeon’s Fees

Not Payable, Except For Telemedicine Consultations

Where Covered by Policy

186

Oxygen Mask

Not Payable

187

Paper Gloves

Not Payable

188

Pelvic Traction Belt

Should be Payable in case of PIVD requiring traction as this is generally not reused

189

Referal Doctor’s Fees

Not Payable

190

Accu Check ( Glucometery/ Strips)

Not Payable. Pre-Hospitilasation or Post-Hospitalisation / Reports and Charts Required/

Device Not Payable

191

Pan Can

Not Payable

192

Sofnet

Not Payable

193

Trolly Cover

Not Payable

194

Urometer, Urine Jug

Not Payable

195

Ambulance

Payable – Ambulance from home to Hospital or inter-hospital shifts is Payable/ RTA – As

Specific Requirement for critical injury is Payable)

196

Tegaderm / Vasofix Safety

Payable – Maximum of 3 in 48 Hrs and then 1 in 24 Hrs

197

Urine Bag

Payable where medicaly necessary till a reasonable cost – Maximum 1 Per 24 Hrs

198

Softovac

Not Payable

199

Stockings

Essential for case like CABG etc. Where it should be paid.

OTHERS

Part of Hospital’s own Costs and not Payable

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