Standard List of Expenses Generally Excluded (“non-admissible expenses") in Hospitalisation Indemnity Policies

STANDARDISATION INITIATIVES BY THE FICCI HEALTH INSURANCE GROUP- A REPORT JULY 2009
S. No. Items Recommendations
A Toiletries/ Cosmetics/ Personal Comfort or Convenience Items
1 Hair removing cream charges 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 Bottle Not Payable
8 Brush Not Payable
9 Cosy Towel Not Payable
10 Hand Wash Not Payable
11 Moisturiser Paste Brush Not Payable
12 Powder Not Payable
13 Razor Payable
14 Towel Not Payable
15 Shoe Cover Not Payable
16 Beauty Services Not Payable
17 Belts/ Braces Essential and Should be Paid at least Specifically for Cases who have undergone surgery
of Thoracic or Lumbar Spine.
18 Buds Not Payable
19 Barber Charges Not Payable
20 Caps Not Payable
21 Cold Pack/hot Pack Not Payable
22 Carry Bags Not Payable
23 Cradle Charges Not Payable
24 Comb Not Payable
25 Disposable Razor Charges ( For Site Preparations) Payable
26 Eau-De-Cologne / Room Freshners Not Payable
27 Eye Pad Not Payable
28 Eye Sheild Not Payable
29 Email / Internet Charges Not Payable
30 Food Charges (other than Patient's Diet Provided by Hospital) Not Payable
31 Foot Cover Not Payable
32 Gown Not Payable
33 Leggings Essential in Bariatric and Varicose Vein Surgery and may be Considered for at least these
Conditions where Surgery itself is Payable.
34 Laundry Charges Not Payable
35 Mineral Water Not Payable
36 Oil Charges Not Payable
37 Sanitary Pad Not Payable
38 Slippers Not Payable
39 Telephone Charges Not Payable
40 Tissue Paper Not Payable
41 Tooth Paste Not Payable
42 Tooth Brush Not Payable
43 Guest Services Not Payable
44 Bed Pan Not Payable
45 Bed Under Pad Charges Not Payable
46 Camera Cover Not Payable
47 Care Free Not Payable
48 Cliniplast Not Payable
49 Crepe Bandage Not Payable/ Payable by the Patient
50 Curapore Not Payable
51 Diaper Of Any Type Not Payable
52 DVD, CD Charges Not Payable ( However If CD Is Specifically Sought by Insurer/TPA then Payable)
53 Eyelet Collar Not Payable
54 Face Mask Not Payable
55 Flexi Mask Not Payable
56 Gause Soft Not Payable
57 Gauze Not Payable
58 Hand Holder Not Payable
59 Hansaplast/ Adhesive Bandages Not Payable
60 Lactogen/ Infant Food Not Payable
61 Slings Reasonable costs for one sling in case of Upper Arm Fractures may be Considered
B Items Specifically Excluded in Policies
62 Weight Control Programs/ Supplies/ Services Exclusion in Policy Unless Otherwise Specified
63 Cost Of Spectacles/ Contact Lenses/ Hearing Aids Etc., Exclusion in Policy Unless Otherwise Specified
64 Dental Treatment Expenses That Do Not Require Hospitalisation Exclusion in Policy Unless Otherwise Specified
65 Hormone Replacement Therapy Exclusion in Policy Unless Otherwise Specified
66 Home Visit Charges Exclusion in Policy Unless Otherwise Specified
67 Infertility/ Subfertility/ Assisted Conception Procedure Exclusion in Policy Unless Otherwise Specified
68 Obesity (including Morbid Obesity) Treatment Exclusion in Policy Unless Otherwise Specified
69 Psychiatric & Psychosomatic Disorders Exclusion in Policy Unless Otherwise Specified
70 Corrective Surgery For Refractive Error Exclusion in Policy Unless Otherwise Specified
71 Treatment Of Sexually Transmitted Diseases Exclusion in Policy Unless Otherwise Specified
72 Donor Screening Charges Exclusion in Policy Unless Otherwise Specified
73 Admission/registration Charges Exclusion in Policy Unless Otherwise Specified
74 Hospitalisation For Evaluation/ Diagnostic Purpose Exclusion in Policy Unless Otherwise Specified
75 Expenses For Investigation/ Treatment Irrelevant To The Disease For Which Exclusion in Policy Not Payable Unless Otherwise Specified
Admitted Or Diagnosed
76 Any Expenses When The Patient Is Diagnosed With Retro Virus + Or Suffering Not Payable As Per HIV/ AIDS Exclusion
From /HIV/ Aids Etc Is Detected/ Directly Or Indirectly
77 Stem Cell Implantation/ Surgery Not Payable Except Bone Marrow Transplantation Where Covered By Policy
C Items Which form Part of Hospital Services where Separate Consumables are not Payable but the Service is
78 Ward And Theatre Booking Charges Payable Under OT Charges, Not Payable Separately
79 Arthroscopy & Endoscopy Instruments Rental Charged By The Hospital Payable. Purchase of Instruments Not Payable.
80 Microscope Cover Payable Under OT Charges, Not Payable Separately
81 Surgical Blades,harmonic Scalpel,shaver Payable Under OT Charges, Not Payable Separately
82 Surgical Drill Payable Under OT Charges, Not Payable Separately
83 Eye Kit Payable Under OT Charges, Not Payable Separately
84 Eye Drape Payable Under OT Charges, Not Payable Separately
85 X-Ray Film Payable Under Radiology Charges, Not As Consumable
86 Sputum Cup Payable Under Investigation Charges, Not As Consumable
87 Boyles Apparatus Charges Part Of Ot Charges, Not Seperately
88 Blood Grouping And Cross Matching Of Donors Samples Part Of Cost Of Blood, Not Payable
89 Savlon Not Payable-Part of Dressing Charges
90 Band Aids, Bandages, Sterile Injections, Needles, Syringes Not Payable - Part of Dressing Charges
91 Cotton Not Payable-Part of Dressing Charges
92 Cotton Bandage Not Payable-Part of Dressing Charges
93 Micropore/ Surgical Tape Not Payable-payable By The Patient When Prescribed, Otherwise Included As Dressing
Charges
94 Blade Not Payable
95 Apron Not Payable -Part of Hospital Services/Disposable Linen to Be Part of OT/ ICU Charges

96 Torniquet Not Payable (service Is Charged by Hospitals, Consumables Cannot Be Separately

Charged)
97 Orthobundle, Gynaec Bundle Part of Dressing Charges
98 Urine Container Not Payable
D Elements Of Room Charge
99 Luxury Tax Policy Exclusion - Not Payable. If there is no Policy Exclusion, then Actual Tax Levied By
Government is Payable - Part of Room Charge for Sub Limits
100 HVAC Part of Room Charge Not Payable Separately
101 House Keeping Charges Part of Room Charge Not Payable Separately
102 Service Charges Where Nursing Charge Also Charged Part of Room Charge Not Payable Separately
103 Television & Air Conditioner Charges Payable Under Room Charges Not If Separately Levied
104 Surcharges Part of Room Charge Not Payable Separately
105 Attendant Charges Not Payable - Part of Room Charges
106 IM/ IV Injection Charges Part of Nursing Charges, Not Payable
107 Clean Sheet Part of Laundry/housekeeping Not Payable Separately
108 Extra Diet of Patient(other than that which Forms Part of Bed Charge) Not Payable if it is a Policy Exclusion. Ogherwise Patient Diet Provided by Hospital is
Payable
109 Blanket/warmer Blanket Not Payable- Part of Room Charges
E Administrative or Non-medical Charges
110 Admission Kit Not Payable
111 Birth Certificate Not Payable
112 Blood Reservation Charges And Ante Natal Booking Charges Not Payable
113 Certificate Charges Not Payable
114 Courier Charges Not Payable
115 Convenyance Charges Not Payable
116 Diabetic Chart Charges Not Payable
117 Documentation Charges / Administrative Expenses Not Payable
118 Discharge Procedure Charges Not Payable
119 Daily Chart Charges Not Payable
120 Entrance Pass / Visitors Pass Charges Not Payable
121 Expenses Related To Prescription On Discharge To Be Claimed By Patient Under Post -Hosp Where Admissible
122 File Opening Charges Not Payable
123 Incidental Expenses / Misc. Charges (not Explained) Not Payable
124 Medical Certificate Not Payable
125 Maintainance Charges Not Payable
126 Medical Records Not Payable
127 Preparation Charges Not Payable
128 Photocopies Charges Not Payable
129 Patient Identification Band / Name Tag Not Payable
130 Washing Charges Not Payable
131 Medicine Box Not Payable
132 Mortuary Charges Payable Upto 24 Hrs, Shifting Charges Not Payable
133 Medico Legal Case Charges (MLC Charges) Not Payable
F External Durable Devices
134 Walking Aids Charges Not Payable
135 Bipap Machine Not Payable
136 Commode Not Payable Not Payable
137 CPAP/ CPAD Equipments Device Not Payable
138 Infusion Pump - Cost Device Not Payable
139 Oxygen Cylinder (for Usage Outside The Hospital) Not Payable
140 Pulseoxymeter Charges Device Not Payable
141 Spacer Not Payable
142 Spirometre Device Not Payable
143 Spo2 Probe Not Payable
144 Nebulizer Kit Not Payable
145 Steam Inhaler Not Payable
146 Armsling Not Payable
147 Thermometer Not Payable (paid By Patient)
148 Cervical Collar Not Payable
149 Splint Not Payable
150 Diabetic Foot Wear Not Payable
151 Knee Braces ( Long/ Short/ Hinged) Not Payable
152 Knee Immobilizer/shoulder Immobilizer Not Payable
153 Lumbo Sacral Belt Essential And Should Be Paid At Least Specifically For Cases Who Have Undergone
Surgery Of Lumbar Spine
154 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
155 Ambulance Collar Not Payable
156 Ambulance Equipment Not Payable
157 Microsheild Not Payable
158 Abdominal Binder Essential and should be Paid at least in Post Surgery Patients of Major Abdominal Surgery
Including TAH, LSCS, Incisional Hernia Repair, Exploratory Laparotomy for Intestinal
Obstruction, Liver Transplant Etc.
G Items Payable If Supported By A Prescription
159 Betadine \ Hydrogen Peroxide\spirit\dettol \Savlon\ Disinfectants Etc May Be Payable When Prescribed For Patient, Not Payable For Hospital use In OT or
Ward Or For Dressings Ward Or For Dressings
160 Private Nurses Charges- Special Nursing Charges Not Payable if policy excludes; Post Hospitalization Nursing Charges Not Payable
161 Nutrition Planning Charges - Dietician Charges- Diet Charges If Policy Excludes Diet Charges - Not payable; Patient Diet Provided By Hospital Is Payable

162 Alex Sugar Free Payable -Sugar Free Variants Of Admissable Medicines Are Not Excluded
163 Cream Powder Lotion (Toileteries are Not Payable, only Prescribed Medical Payable When Prescribed
Pharmaceuticals Payable)
164 Digene Gel/ Antacid Gel Payable When Prescribed
165 ECG Electrodes Upto 5 Electrodes Are Required For Every Case Visiting OT or ICU. For Longer Stay In ICU,
May Require A Change And At Least One Set Every Second Day Must Be Payable.

166 Gloves Sterilized Gloves Payable / Unsterilized Gloves Not Payable

167 HIV Kit Payable - Pre-Operative Screening
168 Listerine/ Antiseptic Mouthwash Payable When Prescribed
169 Lozenges Payable When Prescribed
170 Mouth Paint Payable When Prescribed
171 Nebulisation Kit If Used During Hospitalization is Payable Reasonably
172 Neosprin Payable When Prescribed
173 Novarapid Payable When Prescribed
174 Volini Gel/ Analgesic Gel Payable When Prescribed
175 Zytee Gel Payable When Prescribed
176 Vaccination Charges Routine Vaccination Not Payable / Post Bite Vaccination Payable
H Part of Hospital's own Costs and not Payable
177 AHD Not Payable - Part of Hospital's Internal Cost
178 Alcohol Swabes Not Payable - Part of Hospital's Internal Cost
179 Scrub Solution/sterillium Not Payable - Part of Hospital's Internal Cost
180 Vaccine Charges For Baby Not Payable
181 Aesthetic Treatment / Surgery Not Payable
182 TPA Charges Not Payable
183 Visco Belt Charges Not Payable
184 Any Kit With No Details Mentioned [delivery Kit, Orthokit, Recovery Kit, Etc] Not Payable

185 Examination Gloves Not Payable

186 Kidney Tray Not Payable
187 Mask Not Payable
188 Ounce Glass Not Payable
189 Outstation Consultant's/ Surgeon's Fees Not Payable, Except For Telemedicine Consultations Where Covered by Policy
190 Oxygen Mask Not Payable
191 Paper Gloves Not Payable
192 Pelvic Traction Belt Should Be Payable In Case of PIVD Requiring Traction As This Is Generally Not Reused

193 Referal Doctor's Fees Not Payable

194 Accu Check ( Glucometery/ Strips) Not Payable. Pre-Hospitilasation or Post-Hospitalisation / Reports And Charts Required/
Device Not Payable
195 Pan Can Not Payable
196 Sofnet Not Payable
197 Trolly Cover Not Payable
198 Urometer, Urine Jug Not Payable
199 Ambulance Payable as per the terms of the policy - (Normally ambulance From Home To Hospital or
Interhospital Shifts Is Payable/ RTA - As Specific Requirement for critical injury Is Payable)

200 Tegaderm / Vasofix Safety Payable - Maximum of 3 In 48 Hrs And Then 1 In 24 Hrs
201 Urine Bag Payable Where Medicaly Necessary Till A Reasonable Cost Maximum 1 Per 24 Hrs
202 Softovac Not Payable
203 Stockings Essential For Case Like CABG Etc. Where It Should Be Paid.