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Health policy will not pay all your hospitalization expenses

Most people experience an agonizing shock when they receive their hospitalization bill.

Of course, gigantic medical bills even for minor and insignificant ailments can be quite horrifying.

However, the bigger blow comes when your health insurance policy pays only a part of total hospital bill; leaving you to bear the burden of the balance amount, which itself may add up to a neat sum. 


There are many items of medical expenses, that are not payable under a typical health insurance policy. Earlier this was left to the discretion of each individual insurer. 

Thankfully, under its health policy standardization initiative, IRDA has prescribed a list of such expenses that would normally be excluded from the claim payable to you.

For your knowledge, the broad details... the actual list runs into 199 items... of the same are listed below. (By the way, if any insurance company wants to include them in your claim amount, it is free to do so.)

A. Items specifically excluded
Weight control services or programs, cost of spectacles, hearing aids, contact lenses, dental treatment, hormone replacement therapy, donor screening charges, home visit charges, obesity treatment, psychiatric and psychosomatic treatment, hospitalization for diagnostic purposes, etc.

B. Items where separate consumables are not payable but services are (payable as part of main expense only; not payable separately)
Ward and theatre booking charges, surgical drill, x-ray film, apron tourniquet, surgical tape, cotton bandage, eye kit, needles, syringes, etc.

C. External durable devices
Walking aid charges, bipap machine, steam inhaler, ambulance equipment, spacer, spo2 probe, armsling, cervical collar, splint, knee braces, diabetic foot wear, microshield, etc.

D. Items payable if supported by a prescription
Private nurses charges, dietician charges, disinfectants, ECG electrodes, gloves, vaccination charges, nebulization kit, antiseptic mouthwash, analgesic gel, etc.

E. Elements of room charge (only as part of room charge; not payable separately)
Housekeeping charges, attendant charges, IM IV injection charges, clean sheet, blanket, luxury tax, TV / AC charges, etc.

F. Toiletries, Cosmetics, Personal comfort or convenience items
Baby food, baby bottles, brush, shoe cover, caps, cold/hot packs, cradle charges, powder, eye shield, room fresheners, gown, mineral water, tissue paper, bed pan, gauze, infant food, diaper, laundry charges, etc.

G. Administrative or non-medical charges
Admission kit, birth certificate, blood reservation charges, diabetic chart charges, discharge procedure charges, medicine box, medico legal case charges, patient identification tag, medical certificate, entrance/visitors pass, medical records, etc.

H. Part of hospital's own costs and not payable
AHD, alcohol swabs and scrub solutions.

I.  Others
Aesthetic treatment, TPA charges, examination gloves, mask, paper gloves, oxygen mask, softovac, urometer, pan can, referral doctor's fees, ounce glass, etc. 

Don't be ignorant about your medical insurance policy. It comes with many terms and conditions, such as pre-existing illnesses, co-payment, network hospitals, deductibles, exclusions and more. These can have a major impact on your medical bills and the claim settlement thereof. As such, you must study your policy document thoroughly so as to avoid any unpleasantness later.

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