List of Non Payable Items in Health Insurance

ANNEXURE II: LIST OF EXPENSES EXCLUDED (“NON-MEDICAL”)
SNO LIST OF EXPENSES EXCLUDED (“NON-MEDICAL”) SUGGESTIONS
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS
1 HAIR REMOVAL CREAM Not Payable
2 BABY CHARGES (UNLESS SPECIFIED/INDICATED) Not Payable
3 BABY FOOD Not Payable
4 BABY UTILITES CHARGES Not Payable
5 BABY SET Not Payable
6 BABY BOTTLES Not Payable
7 BRUSH Not Payable
8 COSY TOWEL Not Payable
9 HAND WASH Not Payable
10 M01STUR1SER PASTE BRUSH Not Payable
11 POWDER Not Payable
12 RAZOR Payable
13 SHOE COVER Not Payable
14 BEAUTY SERVICES Not Payable
15 BELTS/ BRACES Essential and may be paid specifically for cases

who have undergone surgery of thoracic or

lumbar spine.

16 BUDS Not Payable
17 BARBER CHARGES Not Payable
18 CAPS Not Payable
19 COLD PACK/HOT PACK Not Payable
20 CARRY BAGS Not Payable
21 CRADLE CHARGES Not Payable
22 COMB Not Payable
23 DISPOSABLES RAZORS CHARGES ( for site preparations) Payable
24 EAU-DE-COLOGNE / ROOM FRESHNERS Not Payable
25 EYE PAD Not Payable
26 EYE SHEILD Not Payable
27 EMAIL / INTERNET CHARGES Not Payable
28 FOOD CHARGES (OTHER THAN PATIENT’S DIET PROVIDED BY

HOSPITAL)

Not Payable
29 FOOT COVER Not Payable
30 GOWN Not Payable
31 LEGGINGS Essential in bariatric and varicose vein surgery and

should be considered for these conditions where

surgery itself is payable.

32 LAUNDRY CHARGES Not Payable
33 MINERAL WATER Not Payable
34 OIL CHARGES Not Payable
35 SANITARY PAD Not Payable
36 SLIPPERS Not Payable
37 TELEPHONE CHARGES Not Payable
38 TISSUE PAPER Not Payable
39 TOOTH PASTE Not Pavable
40 TOOTH BRUSH Not Payable
41 GUEST SERVICES Not Payable
42 BED PAN Not Payable

 

43 BED UNDER PAD CHARGES Not Payable
44 CAMERA COVER Not Payable
45 CLINIPLAST Not Payable
46 CREPE BANDAGE Not Payable/ Payable by the patient
47 CURAPORE Not Payable
48 DIAPER OF ANY TYPE Not Payable
49 DVD, CD CHARGES Not Payable ( However if CD is specifically sought

by In surer/TPA then payable)

50 EYELET COLLAR Not Payable
51 FACE MASK Not Payable
52 FLEXI MASK Not Payable
53 GAUSE SOFT Not Payable
54 GAUZE Not Payable
55 HAND HOLDER Not Payable
56 HANSAPLAST/ADHESIVE BANDAGES Not Payable
57 INFANT FOOD Not Payable
58 SLINGS Reasonable costs for one sling in case of upper

arm fractures should be considered

ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES
59 WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES Not Payable
60 COST OF SPECTACLES/ CONTACT LENSES/ HEARING AIDS

ETC.,

Not Payable
61 DENTAL TREATMENT EXPENSES THAT DO NOT REQUIRE

HOSPITALISATION

Not Payable
62 HORMONE REPLACEMENT THERAPY Not Payable
63 HOME VISIT CHARGES Not Payable
64 INFERTILITY/ SUBFERTILITY/ ASSISTED CONCEPTION

PROCEDURE

Not Payable
65 OBESITY (INCLUDING MORBID OBESITY) TREATMENT IF

EXCLUDED IN POLICY

Not Payable
66 PSYCHIATRIC & PSYCHOSOMATIC DISORDERS Not Payable
67 CORRECTIVE SURGERY FOR REFRACTIVE ERROR Not Payable
68 TREATMENT OF SEXUALLY TRANSMITTED DISEASES Not Payable
69 DONOR SCREENING CHARGES Not Payable
70 ADMISSION/REGISTRATION CHARGES Not Payable
71 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE Not Payable
72 EXPENSES FOR INVESTIGATION/ TREATMENT IRRELEVANT TO THE DISEASE FOR WHICH ADMITTED OR DIAGNOSED Not Payable
73 ANY EXPENSES WHEN THE PATIENT IS DIAGNOSED WITH

RETRO VIRUS + OR SUFFERING FROM /HIV/ AIDS ETC IS

DETECTED/ DIRECTLY OR INDIRECTLY

Not Payable
74 STEM CELL IMPLANTATION/ SURGERY and storage Not Payable
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE
75 WARD AND THEATRE BOOKING CHARGES Payable under OT Charges, not separately
76 ARTHROSCOPY & ENDOSCOPY INSTRUMENTS Rental charged by the Hospital payable. Purchase

of Instruments Not Payable.

77 MICROSCOPE COVER Payable under OT Charges, not separately
78 SURGICAL BLADES, HARMONIC SCALPEL, SHAVER Payable under OT Charges, not separately
79 SURGICAL DRILL Payable under OT Charges, not separately

 

80 EYE KIT Payable under OT Charges, not separately
81 EYE DRAPE Payable under OT Charges, not separately
82 X-RAY FILM Payable under Radiology Charges, not as

consumable

83 SPUTUM CUP Payable under Investigation Charges, not as

consumable

84 BOYLES APPARATUS CHARGES Part of OT Charges, not separately
85 BLOOD GROUPING AND CROSS MATCHING OF DONORS

SAMPLES

Part of Cost of Blood, not payable
86 Antiseptic or disinfectant lotions Not Payable – Part of Dressing Charges
87 BAND AIDS, BANDAGES, STERLILE INJECTIONS, NEEDLES,

SYRINGES

Not Payable – Part of Dressing charges
88 COTTON Not Payable -Part of Dressing Charges
89 COTTON BANDAGE Not Payable- Part of Dressing Charges
90 MICROPORE/ SURGICAL TAPE Not Payable – Part of Dressing Charges
91 BLADE Not Payable
92 APRON Not Payable
93 TORNIQUET Not Payable
94 ORTHOBUNDLE, GYNAEC BUNDLE Not Payable, Part of Dressing Charges
95 URINE CONTAINER Not Payable
ELEMENTS OF ROOM CHARGE
96 LUXURY TAX Actual tax levied by government is payable. Part of

room charge for sub limits

97 HVAC Part of room charge, Not Payable separately
98 HOUSE KEEPING CHARGES Part of room charge, Not Payable separately
99 SERVICE CHARGES WHERE NURSING CHARGE ALSO

CHARGED

Part of room charge, Not Payable separately
100 TELEVISION & AIR CONDITIONER CHARGES Part of room charge, Not Payable separately
101 SURCHARGES Part of room charge, Not Payable separately
102 ATTENDANT CHARGES Part of room charge, Not Payable separately
103 IM IV INJECTION CHARGES Part of nursing charge, Not Payable separately
104 CLEAN SHEET Part of Laundry / Housekeeping, Not Payable

separately

105 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS

PART OF BED CHARGE)

Patient Diet provided by Hospital is payable
106 BLANKET/WARMER BLANKET Part of room charge, Not Payable separately
ADMINISTRATIVE OR NON – MEDICAL CHARGES
107 ADMISSION KIT Not Payable
108 BIRTH CERTIFICATE Not Payable
109 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING

CHARGES

Not Payable
110 CERTIFICATE CHARGES Not Payable
111 COURIER CHARGES Not Payable
112 CONVENYANCE CHARGES Not Payable
113 DIABETIC CHART CHARGES Not Payable
114 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES Not Payable
115 DISCHARGE PROCEDURE CHARGES Not Payable
116 DAILY CHART CHARGES Not Payable

 

117 ENTRANCE PASS / VISITORS PASS CHARGES Not Payable
118 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE Payable under Post- Hospitalisation where

admissible

119 FILE OPENING CHARGES Not Payable
120 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED) Not Payable
121 MEDICAL CERTIFICATE Not Payable
122 MAINTENANCE CHARGES Not Payable
123 MEDICAL RECORDS Not Payable
124 PREPARATION CHARGES Not Payable
125 PHOTOCOPIES CHARGES Not Payable
126 PATIENT IDENTIFICATION BAND / NAME TAG Not Payable
127 WASHING CHARGES Not Payable
128 MEDICINE BOX Not Payable
129 MORTUARY CHARGES Payable up to 24 hrs, shiGing charges not payable
130 MEDICO LEGAL CASE CHARGES (MLC CHARGES) Not Payable
EXTERNAL DURABLE DEVICES
131 WALKING AIDS CHARGES Not Payable
132 BIPAP MACHINE Not Payable
133 COMMODE Not Payable
134 CPAP/ CAPD EQUIPMENTS Device not payable
135 INFUSION PUMP – COST Device not payable
136 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL) Not Payable
137 PULSEOXYMETER CHARGES Device not payable
138 SPACER Not Payable
139 SPIROMETRE Device not payable
140 SP02 PROBE Not Payable
141 NEBULIZER KIT Not Payable
142 STEAM INHALER Not Payable
143 ARMSLING Not Payable
144 THERMOMETER Not Payable
145 CERVICAL COLLAR Not Payable
146 SPLINT Not Payable
147 DIABETIC FOOT WEAR Not Payable
148 KNEE BRACES ( LONG/ SHORT/ HINGED) Not Payable
149 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER Not Payable
150 LUMBOSACRAL BELT Payable for surgery of lumbar spine.
 

151

 

NIMBUS BED OR WATER OR AIR BED CHARGES

Payable for any ICU patient requiring more than 3 days in ICU, all patients with paraplegia

/quadriplegia for any reason and at reasonable cost of approximately Rs 200/day

152 AMBULANCE COLLAR Not Payable
153 AMBULANCE EQUIPMENT Not Payable
154 MICROSHEILD Not Payable

 

 

155

 

ABDOMINAL BINDER

Essential and should be paid in post-surgery patients of major abdominal surgery including TAH, LSCS, incisional hernia repair, exploratory laparotomy for intestinal obstruction, liver

transplant etc.

ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION
156 BETADINE / HYDROGEN PEROXIDE / SPIRIT / DISINFECTANTS

ETC

Not Payable
157 PRIVATE NURSES CHARGES – SPECIAL NURSING CHARGES

Post hospitalization nursing charges

Not Payable
 

158

NUTRITION PLANNING CHARGES – DIETICIAN

CHARGESDIET CHARGES

 

Patient Diet provided by hospital is payable

159 SUGAR FREE Tablets Payable -Sugar free variants of admissible

medicines are not excluded

160 CREAMS POWDERS LOTIONS Payable when prescribed (Toiletries are not

payable, only prescribed medical pharmaceuticals

payable)

161 Digestion gels Payable when prescribed
162 ECG ELECTRODES One set every second day is Payable.
163 GLOVES Sterilized Gloves payable / unsterilized gloves not payable
164 HIV KIT payable Pre-operative screening
165 LISTERINE/ ANTISEPTIC MOUTHWASH Payable when prescribed
166 LOZENGES Payable when prescribed
167 MOUTH PAINT Payable when prescribed
168 NEBULISATION KIT If used during Hospitalisation is Payable

reasonably

169 NOVARAPID Payable when prescribed
170 VOLINI GEL/ ANALGESIC GEL Payable when prescribed
171 ZYTEE GEL Payable when prescribed
172 VACCINATION CHARGES Routine Vaccination not Payable / Post Bite

Vaccination Payable

PART OF HOSPITAL’S OWN COSTS AND NOT PAYABLE
173 AHD Not Payable – Part of Hospital’s internal Cost
174 ALCOHOL SWABES Not Payable – Part of Hospital’s internal Cost
175 SCRUB SOLUTION/STERILLIUM Not Payable – Part of Hospital’s internal Cost
OTHERS
176 VACCINE CHARGES FOR BABY Not Payable
177 AESTHETIC TREATMENT / SURGERY Not Payable
178 TPA CHARGES Not Payable
179 VISCO BELT CHARGES Not Payable
180 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT,

ORTHOKIT, RECOVERY KIT, ETC]

Not Payable
181 EXAMINATION GLOVES Not payable
182 KIDNEY TRAY Not Payable
183 MASK Not Payable
184 OUNCE GLASS Not Payable

 

185 OUTSTATION CONSULTANT’S/ SURGEON’S FEES Not payable
186 OXYGEN MASK Not Payable
187 PAPER GLOVES Not Payable
188 PELVIC TRACTION BELT Payable in case of PIVD requiring traction
189 REFERAL DOCTOR’S FEES Not Payable
190 ACCU CHECK (Glucometery/ Strips) Not payable pre Hospitalisation or post

Hospitalisation / Reports and Charts required /

Device not payable

191 PAN CAN Not Payable
192 SOFNET Not Payable
193 TROLLY COVER Not Payable
194 UROMETER, URINE JUG Not Payable
195 AMBULANCE Payable
196 TEGADERM / VASOFIX SAFETY Payable – maximum of 3 in 48 hrs and then 1 in 24

hrs

197 URINE BAG Payable where Medically Necessary – maximum 1

per 24 hrs

198 SOFTOVAC Not Payable
199 STOCKINGS Payable for case like CABG etc.

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