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What health insurance does not pay for

LiveMint logoLiveMint 26-06-2017 Deepti Bhaskaran

A health insurance policy pays for your hospital bills, but did you know that you may still end up paying a part of your hospital bills from your pocket? That’s because there are certain items that are listed as non-payable by the insurance policy. So, you need to pay for these yourself. Read on to understand what your insurance policy won’t pay for. 

The Insurance Regulatory and Development Authority of India (Irdai) has standardised the list of expenses that are generally excluded from a health insurance policy. Of course, insurers are free to include some of the items from the list but they cannot add to the list of exclusions.

About 200 items are not payable by your health insurance policy. These are further divided into nine categories, ranging from items of personal comfort to specified medical procedures and administrative expenses. 

In terms of medical procedures, your health insurance policy will not pay for cosmetic surgeries or dental treatment unless it is required due to an accident and requires hospitalization. Treatment for AIDS is also not covered. Medical expenses on account of self - inflicted injuries or alcohol or drug use are also not payable. 

You cannot use your health insurance policy to pay for any weight control programmes. Even treatment for psychiatric and psychosomatic disorders is not covered by your health insurance policy. 

Furthermore, hospitalization for evaluation and diagnostic purposes is also not payable by your health insurance policy. Even when you get hospitalized, any expenses for investigations or treatment that are not relevant to the ailment for which you were hospitalized, is not payable by your policy. 

In terms of non-payable items, your health insurance policy will not pay for toiletries, cosmetics and convenience items such as telephone charges, laundry charges and internet costs. Even medical items such as the cost of spectacles, contact lenses, hearing aids, adhesive bandage, crepe bandage, unsterilized gloves and gauze are not payable. 

In fact, room-related expenses such as television and air conditioning charges, housekeeping charges and attendant charges are also not payable if they are billed separately and are not part of the room costs. Then there are administrative costs like the admission kits, discharge procedure costs, entrance passes or visitors pass expenses and patient identification bands or name tags. These will also not be payable by your policy. 

It’s important to know what all is not payable, as it can work out to be a neat out-of-pocket expense for you. According to an insurer we spoke to, non-payable expenses can constitute anywhere between 4% to 9% of the total hospital bill. You can read the complete list of exclusions here

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