People buy health insurance to curb out-of-pocket expenses while paying hospital bills. However, even if you buy a policy, it will not cover all costs because the insurance policy lists certain items as non-payable.
There is a list of around 199 items specified by the Insurance Regulatory and Development Authority of India (Irdai) that the health insurer does not pay as part of the health insurance policy.
These items include surgical blades, instruments like pulse oximeter, gauze, cotton and bandages, bedsheets, gloves, hand wash, tissue papers, gowns used during hospitalization, and housekeeping charges, So, any costs incurred on these are called non-standard charges or non-admissible expenses in a medical bill.
These non-payable expenses typically account for 5-10% of the medical bill. For instance, if the medical bill is around ₹10 lakh, this can range from ₹50,000 to ₹1 lakh.
Siddharth Singhal, business head – health Insurance, Policybazaar.com, said, “There are a couple of reasons why Irdai has excluded several items from a health insurance policy. Firstly, non-medical items are usually affordable, and you can pay such bills from your pocket. Moreover, Irdai has specified these items to safeguard health insurance companies from excessive claims. It isn’t easy to ascertain the usage of non-medical items, for instance, how many gloves or gowns were used by the doctors during treatment, the cost of such gloves or gowns, etc. So, this set of expenses is susceptible to excessive claims, and hence is excluded from the health insurance policy per view.”
What policyholders can do?
Earlier, policyholders have had to pay expenses related to these non-payable items. However, after the pandemic, many insurers have come up with riders which cover a list of consumable items that are a part of these non-medical expenses.
By paying an additional 7- 10% extra on the premium, you can buy this rider and safeguard yourself against non-standard costs. Singhal said there are options for the policyholder to reduce out-of-pocket expenses.
He said, “You can opt for insurers who provide OPD cover along with their health insurance under which you get the coverage for expenses such as consultations, diagnostics and pharmacy, etc. The insurer might completely cover the OPD expenses or provide a certain type of discount to reduce the out-of-pocket expense.”
Mint take: You should read the list of items covered by insurers while buying a health insurance rider because the list may vary based on the insurer. Moreover, a policyholder should choose a policy that doesn’t have sub-limits on room rent, illnesses, etc., as the impact of non-payable items would generally cost around 5-10% of your medical bill. A sub-limit, though, can prove to be very costly.