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Non-Medical Expenses in Health Insurance as Per IRDA Guidelines

Team AckoDec 9, 2021

If you are shopping for the right health insurance, you want to be sure that it covers important treatments, if not all of them. Medical insurance mitigates financial losses, especially during unforeseen medical emergencies. But, medical insurance also follows a strict claim process as directed by the Insurance Regulatory and Development Authority of India (IRDAI). 

Non-Medical Expenses in Health Insurance

The IRDAI has excluded some medical expenses, referred to as non-medical expenses in health insurance, to curb misuse of medical insurance. In this article, we have listed the non-medical expenses in medical insurance so that you are aware of the policy’s exclusions.

What are non-medical expenses in health insurance?

Health insurance offers financial coverage during planned and unplanned hospitalisation. However, there are several items charged during your hospitalisation which are excluded from the insurance coverage. The cost of these excluded items is known as a non-medical expense.

List of non-medical expenses as per IRDAI guidelines

As per the IRDAI’s guidelines, some optional medical items utilised during the treatment or hospitalisation are not considered as medical expenses when settling insurance claims. The non-medical expenses list is categorised based on the treatment and hospitalisation.

Optional items

  • Food (other than provided by the hospital)  

  • Mineral water

  • Baby food

  • Nebuliser kit

  • Laundry/attendant charges

  • Thermometer

  • Belts/braces

  • Beauty services

  • Carry bags

Non-medical expenses in treatment cost

During hospitalisation, healthcare professionals use certain items for treatment. Here are the non-medical expenses incurred in treatment.

  • Registration/admission charges

  • Spirit, disinfectant, hydrogen peroxide

  • Urine container

  • Infusion pump charges

  • Blood reservation cost

  • Nutritionist or dietician charges

  • Vaccination cost

  • Antiseptic mouthwash

  • HIV kit

  • Diabetic footwear

Non-medical expenses in the room charges

Here is the list of non-medical expenses about the room charges during hospitalisation.

  • Hand wash

  • Tissue paper

  • Housekeeping charges

  • Comb, caps, slippers

  • Toothpaste and toothbrush

  • Pulse oximeter charges

  • Gown

  • Foot cover

  • Cold pack/hot pack

  • Buds

Non-medical expenses in procedure costs

Following are the items that are considered as non-medical expenses in procedural costs.

  • Surgical blades

  • Hair removal cream

  • Bandages, cotton

  • Disposable razors

  • Surgical drill

  • Apron

  • Arthroscopy and Endoscopy instrument charges

  • Harmon scalpel blades

  • Gauze blades

  • Eye pad

Other non-payable medical expenses

Here are additional non-medical expenses in health insurance.

  • Barber charges

  • Syringes, needles, sterilised injections

  • Washing charges

  • Medicine box

  • Paper gloves

  • Digestion gels

  • Referral doctor’s fees

How to know more about non-medical expenses before claims?

The exclusions are followed across the health insurance industry. The IRDAI has specified the list of non-medical expenses and is listed on the insurer’s website. To be a smart health insurance buyer, you must know of the inclusions and exclusions of the policy to avoid any surprises in the future, especially during unforeseen hospitalisation.

Read the terms and conditions and understand what is not covered in health insurance so that you can avoid unforeseen surprises and financial losses.

In a nutshell

Understanding the non-medical expenses in health insurance is not a cumbersome task. Insurers such as ACKO provide buyers with access to vast amounts of information via secure websites. This information can enable you to select the right health insurance plan. 

While non-medical expenses are to be paid out-of-pocket, the cost of these items is generally lower. You must read the inclusions and exclusions of a health insurance plan before finalising the right plan for you and your family.

Frequently asked questions

Here are some of the common questions about non-medical expenses in health insurance.

What are non-reimbursable medical expenses?

Non-reimbursable medical expenses are also called non-medical expenses. Medical expenses that are not covered by the health insurance plan are known as non-reimbursable medical expenses.

How can I cover non-medical expenses in my health insurance policy?

Several insurers offer add-on covers for non-medical expenses for an additional premium. You can opt to buy the non-medical expenses add-on cover to increase the scope of the primary 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.

Are pre and post-hospitalisation expenses considered non-medical expenses in health insurance?

Relevant pre and post-hospitalisation expenses will be considered as medical expenses and covered by the health insurance policy. However, it depends on the insurer and the type of policy you opt for.

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CIN: U66000KA2016PLC138288

IRDAI Registration No: 157

Category: Non-Life Insurance

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