What are non medical expenses in health insurance and why are they excluded?

Non-medical expenses are costs incurred by healthcare providers during patient care that are not directly related to the medical treatment. For instance, imagine you’re hospitalized for a cataract procedure. Most hospitals will require you to pay an admission or registration fee before they take you in. The admission fee is part of your medical bill, however, it is classified as a non-medical expense since it is not directly related to your treatment.

Non-medical expenses are generally excluded from insurance coverage since health insurance plans are only expected to pay costs that are directly associated with an individual’s medical treatment.  

What are the most common non-medical expenses in health insurance policies?

In 2016, the insurance regulator of India standardized the definition of non-medical expenses by including a list of 199 items. Insurance companies can rely on this list while drafting the policy document. In other words, insurance companies are free to exclude all the 199 items from insurance cover while designing their policies.

Having said that however, most companies do not exclude all 199 items. Instead, they pick a few items that they want to exclude from insurance coverage and cover the rest. You can find the full list of 199 items in this document.

However, if you want to have a quick look at the top non-medical items that are generally excluded from health insurance policies, here is a detailed guide.

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Most common non-medical expenses (2023)

1) Administrative Charges: When you are enrolled in a hospital, several employees have to maintain and update records associated with your stay. These costs are related to the infrastructure and not necessarily related to medical care. These include things like your admission fee, registration fee, discharge duty costs etc.

2) Toiletries and personal care items: These are personal care products that patients may use during the course of their stay in a hospital. This includes things like toothbrushes, lotions, and towels. If the hospital provides these products, then such costs are generally categorized as non-medical expenses.

3) External medical devices/services: As part of your treatment protocol, doctors may recommend external medical devices or services like weight control programs, spectacles, contact lenses and hearing aids. While these are definitely used as part of your medical treatment, these costs are considered separately and insurance companies generally exclude them from your coverage.

4) Room Facility charges: Insurance companies pay the rental costs associated with your hospital room. However, if certain additional charges are included separately, they will exclude these items. Common charges include television charges, telephone charges, housekeeping charges etc.

Outside of these expenses which are deemed non-medical, insurance companies also exclude medical items called consumables.

An exhaustive list of 50 non-medical items and consumables

What are consumables in medical insurance?

Consumables are medical items that are generally used very quickly during an individual's stay at the hospital. These include bandages, gloves, face masks, PPE kits, IVs etc.  

Both consumables and non-medical expenses can together contribute up to 10% of the total medical bill and they are both generally excluded from insurance coverage.

How to get coverage for non-medical expenses and consumables?

While most health insurance policies generally exclude non-medical expenses and consumables, some insurance companies promise to cover these costs in full.

Best health insurance plans to cover non-medical expenses

1) Optima Secure (Protect Benefit): Optima Secure is an extremely comprehensive policy. It has no room rent restrictions, no co-pay clause, covers Ayush treatments and has reasonable waiting periods for pre-existing diseases. But more importantly, it also offers Protect Benefit, where it automatically covers several non-medical expenses and consumables including bandages, gloves, PPE kits etc.

2) Care Supreme with Claim Shield Add-on: Care Supreme is Care’s best-selling policy at the moment. It is affordable, extremely comprehensive and has a bunch of add-ons that could add a lot of value for prospective customers. However, if you want to specifically cover consumables and non-medical expenses, then you can simply buy the Claim Shield add-on and rest easy.

3) Niva Bupa Reassure 2.0 with Disease Management Rider: Niva Bupa Reassure 2.0 is perhaps the most loaded policy on paper. However, with the Disease Management Rider, it goes one step ahead and offers coverage for non-medical expenses like Gloves, masks and Nebulization kits.

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Conclusion

It’s always best to read your policy document in full before buying a policy because the list of non-medical expenses can vary depending on the policy you buy. There’s also the fact that these costs alone can add up to 10-15% of your total bill. So if you want better coverage, then it’s best to buy a policy that covers consumables and non-medical expenses.

You can reach out to our advisors at Ditto Insurance for more info.