Non-payable costs in health insurance policy

The Insurance Regulatory & Development Authority of India (IRDAI) has provided a comprehensive list of 200 items of expenses that are excluded from the health insurance policy and are not liable to be paid by the insurance company.

Oct 02, 2017 04:10 IST India Infoline News Service

There are many costs that are not covered by the health insurance policy. The Insurance Regulatory & Development Authority of India (IRDAI) has provided a comprehensive list of 200 items of expenses that are excluded from the health insurance policy and are not liable to be paid by the insurance company.

The items of expenses that are excluded from the health insurance policy can be broadly divided into three categories, namely, administrative expenses, items of personal comfort and specified medical procedures. Let us look at some of the excluded items.

The administrative expenses charged by the hospital such as admission fee, cost of entrance passes and visitors’ passes, patient identification bands and tags, cost of discharge, etc. are not payable by the insurer.

The cost of items of personal comfort and convenience such as telephone, internet, laundry, toiletries and cosmetics are not covered by the health insurance policy. Room-related charges such as television and air-conditioning, attendant and housekeeping charges are also not payable by the insurer if these are billed separately by the hospital and are not part of the cost of room.

In fact, even the costs of some of the medical items such as bandages, gloves, gauges, hearing aids, contact lenses and spectacles are not payable by the insurance company.

In the case of medical procedures, the costs incurred on cosmetic surgeries and weight loss programmes and expenses for treatment of dental problems, AIDs, psychiatric and psychosomatic disorders are not covered by the health policy. Also, the expenses incurred on evaluation and diagnosis after hospitalisation are also excluded from the insurance cover. Further, any expenses incurred on investigations or treatment that are not relevant to the ailment for which the insured was hospitalised will not be reimbursed by the insurance company.

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