ANNEXURE I

List of Expenses Generally Excluded ('Non-admissible Expenses') in Hospitalisation Policy

GUIDELINES ON STANDARDISATION IN HEALTH INSURANCE - IRDA CIRCULAR No IRDA/HLT/CIR/036/02/2013 DATED 20.02.2013
S.No. Items Remarks S.No. Items Remarks
A Toiletries/ Cosmetics/ Personal Comfort or Convenience Items 65 Obesity (including Morbid Obesity) Treatment Excluded in Policy
1 Hair Removing Cream Not Payable if Exclusion in Policy unless otherwise specified
2 Baby Charges (unless specified/indicated) Not Payable 66 Psychiatric & Psychosomatic Disorders Exclusion in Policy
3 Baby Food Not Payable unless otherwise specified
4 Baby Utilites Charges Not Payable 67 Corrective Surgery for Refractive Error Exclusion in Policy
5 Baby Set Not Payable unless otherwise specified
6 Baby Bottles Not Payable 68 Treatment of Sexually Transmitted Diseases Exclusion in Policy
7 Brush Not Payable unless otherwise specified
8 Cosy Towel Not Payable 69 Donor Screening Charges Exclusion in Policy
9 Hand Wash Not Payable unless otherwise specified
10 Moisturiser Paste Brush Not Payable 70 Admission/Registration Charges Exclusion in Policy
11 Powder Not Payable unless otherwise specified
12 Razor Payable 71 Hospitalisation for Evaluation/ Diagnostic Exclusion in Policy
13 Shoe Cover Not Payable Purpose unless otherwise specified
14 Beauty Services Not Payable 72 Expenses for Investigation/ Treatment Exclusion in Policy not payable
15 Belts/ Braces Essential and Should be Paid irrelevant to the Disease for which admitted or diagnosed unless otherwise specified
at least Specifically for Cases 73 Any Expenses when the Patient is diagnosed Retro Virus+or Not Payable as per HIV/ with
who have undergone surgery suffering from /HIV/ Aids etc is detected/ directly or indirectly AIDS Exclusion
of Thoracic or Lumbar Spine. 74 Stem Cell Implantation/ Surgery & Storage Not Payable except Bone
16 Buds Not Payable Marrow Transplantation where
17 Barber Charges Not Payable covered by Policy
18 Caps Not Payable
19 Cold Pack/Hot Pack Not Payable C Items Which form Part of Hospital Services where Separate Consumables are not Payable but
20 Carry Bags Not Payable the Service is
21 Cradle Charges Not Payable 75 Ward and Theatre Booking Charges Payable Under OT Charges,
22 CombNot Payable Not Payable Separately
23 Disposable Razor Charges (For Site Preparations) Payable 76 Arthroscopy & Endoscopy Instruments Rental Charged by the
24 Eau-De-Cologne / Room Freshners Not Payable Hospital Payable. Purchase of
25 Eye Pad Not Payable Instruments Not Payable.
26 Eye Sheild Not Payable 77 Microscope Cover Payable Under OT Charges,
26 Eye Sheild Not Payable Not Payable Separately
27 Email / Internet Charges Not Payable 78 Surgical Blades,Harmonic Scalpel, Shaver Payable Under OT Charges,
28 Food Charges (other than Patient's Diet Provided by Hospital) Not Payable Not Payable Separately
29 Foot Cover Not Payable 79 Surgical Drill Payable Under OT Charges,
30 Gown Not Payable Not Payable Separately
31 Leggings Essential in Bariatric and 80 Eye Kit Payable Under OT Charges,
Varicose Vein Surgery and Not Payable Separately
may be considered for at least 81 Eye Drape Payable Under OT Charges,
these conditions where Not Payable Separately
Surgery itself is Payable. 82 X-Ray Film Payable Under Radiology
32 Laundry Charges Not Payable Charges, Not as Consumable
33 Mineral Water Not Payable 83 Sputum Cup Payable Under Investigation
34 Oil Charges Not Payable Charges, Not as Consumable
35 Sanitary Pad Not Payable 84 Boyles Apparatus Charges Part of OTCharges,
36 Slippers Not Payable Not Seperately
37 Telephone Charges Not Payable 85 Blood Grouping and Cross Matching of Part of Cost of Blood,
38 Tissue Paper Not Payable Donors Samples Not Payable
39 Tooth Paste Not Payable 86 Antiseptic & Disinfectant Lotions Not Payable-Part of
40 Tooth Brush Not Payable
Dressing Charges
41 Guest Services Not Payable
87 Band Aids, Bandages, Sterile Injections, Not Payable -
42 Bed Pan Not Payable
Needles, Syringes Part of Dressing Charges
43 Bed Under Pad Charges Not Payable
88 Cotton Not Payable-Part of
44 Camera Cover Not Payable
45 Cliniplast Not Payable Dressing Charges
46 Crepe Bandage Not Payable/ 89 Cotton Bandage Not Payable-Part of
Payable by the Patient Dressing Charges
47 Curapore Not Payable 90 Micropore/ Surgical Tape Not Payable-payable by the
48 Diaper Of Any Type Not Payable Patient when Prescribed,
49 DVD, CD Charges Not Payable(However if CD otherwise included as
is specifically sought by Dressing Charges
Insurer/TPA then Payable) 91 Blade Not Payable
50 Eyelet Collar Not Payable 92 Apron Not Payable -Part of Hospital
51 Face Mask Not Payable Services/Disposable Linen to
52 Flexi Mask Not Payable be Part of OT/ICU Charges
53 Gause Soft Not Payable 93 Torniquet Not Payable (service is charged
54 Gauze Not Payable by Hospitals, Consumables
55 Hand Holder Not Payable cannot be separately charged)
56 Hansaplast/ Adhesive Bandages Not Payable 94 Orthobundle, Gynaec Bundle Part of Dressing Charges
57 Infant Food Not Payable 95 Urine Container Not Payable
58 SlingsReasonable costs for one D Elements of Room Charge
sling in case of Upper Arm 96 Luxury Tax Policy Exclusion - Not
Fractures may be considered Payable. If there is no Policy
B Items Specifically Excluded in Policies Exclusion, then Actual Tax
59 Weight Control Programs/ Supplies/ Services Exclusion in Policy Levied by Government is
unless otherwise specified Payable - Part of Room
60 Cost Of Spectacles/ Contact Lenses/ Exclusion in Policy Charge for Sub Limits
Hearing Aids Etc., unless otherwise specified 97 HVAC Part of Room Charge
61 Dental Treatment Expenses that do not require Exclusion in Policy Not Payable Separately
Hospitalisation unless otherwise specified 98 House Keeping Charges Part of Room Charge
62 Hormone Replacement Therapy Exclusion in Policy Not Payable Separately
unless otherwise specified 99 Service Charges where Nursing Charge also Part of Room Charge
63 Home Visit Charges Exclusion in Policy charged Not Payable Separately
unless otherwise specified 100 Television & Air Conditioner Charges Payable Under Room Charges
64 Infertility/ Subfertility/ Assisted Conception Exclusion in Policy Not if separately levied
Procedure unless otherwise specified 101 Surcharges Part of Room Charge
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S.No. Items Remarks S.No. Items Remarks
Not Payable Separately or Ward or for dressings
102 Attendant Charges Not Payable - ward or for dressings
Part of Room Charges 157 Private Nurses Charges- Special Nursing Charges Post Hospitalization
103 IM/ IV Injection Charges Part of Nursing Charges, Nursing Charges Not Payable
Not Payable 158 Nutrition Planning Charges - Dietician Patient Diet provided by
104 Clean Sheet Part of Laundry/housekeeping Charges- Diet Charges Hospital is Payable
Not Payable Separately 159 Sugar Free Tablets Payable -Sugar Free variants
105 Extra Diet of Patient(other than that which Not Payable. Patient Diet of admissable medicines are
forms part of Bed Charge) Provided by Hospital is not Excluded
Payable 160 Cream Powder Lotion (Toileteries are Not Payable when
106 Blanket/Warmer Blanket Not Payable- Payable, only Prescribed Medical Prescribed
Part of Room Charges Pharmaceuticals Payable)
E Administrative or Non-medical Charges 161 Digene Gel Payable when Prescribed
107 Admission Kit Not Payable
108 Birth Certificate Not Payable 162 ECG Electrodes Upto 5 Electrodes are required
109 Blood Reservation Charges and Ante Natal Not Payable for every case visiting OT or
Booking Charges ICU. For longer stay in ICU,
110 Certificate Charges Not Payable may Require a Change and at
111 Courier Charges Not Payable least one set every second day
112 Convenyance Charges Not Payable must be Payable.
113 Diabetic Chart Charges Not Payable 163 Gloves Sterilized Gloves Payable /
114 Documentation Charges/ Not Payable Unsterilized Gloves not
Administrative Expenses payable
115 Discharge Procedure Charges Not Payable 164 HIV Kit Payable - Pre-Operative
116 Daily Chart Charges Not Payable Screening
117 Entrance Pass / Visitors Pass Charge Not Payable 165 Listerine/ Antiseptic Mouthwash Payable When Prescribed
118 Expenses Related to Prescription on Discharge To be Claimed by Patient under 166 Lozenges Payable When Prescribed
Post -Hospitalisation where 167 Mouth Paint Payable When Prescribed
admissible 168 Nebulisation Kit If used during Hospitalization
119 File Opening Charges Not Payable is Payable Reasonably
120 Incidental Expenses / Misc. Charges Not Payable 169 Novarapid Payable When Prescribed
(not Explained) 170 Volini Gel/ Analgesic Gel Payable When Prescribed
121 Medical Certificate Not Payable 171 Zytee Gel Payable When Prescribed
122 Maintainance Charges Not Payable 172 Vaccination Charges Routine Vaccination Not
123 Medical Records Not Payable Payable / Post Bite
124 Preparation Charges Not Payable
Vaccination Payable
125 Photocopies Charges Not Payable
H Part of Hospital's own Costs and not Payable
126 Patient Identification Band / Name Tag Not Payable
127 Washing Charges Not Payable 173 AHD Not Payable - Part of
128 Medicine Box Not Payable Hospital's Internal Cost
129 Mortuary Charges Payable Upto 24 Hrs, 174 Alcohol Swabes Not Payable - Part of
Shifting Charges Not Payable Hospital's Internal Cost
130 Medico Legal Case Charges (MLC Charges) Not Payable 175 Scrub Solution/ Sterillium Not Payable - Part of
Hospital's Internal Cost
F External Durable Devices
I OTHERS
131 Walking Aids Charges Not Payable
132 Bipap Machine Not Payable 176 Vaccine Charges for Baby Not Payable
133 Commode Not Payable 177 Aesthetic Treatment / Surgery Not Payable
134 CPAP/ CPAD Equipments Device Not Payable 178 TPA Charges Not Payable
135 Infusion Pump - Cost Not Payable 179 Visco Belt Charges Not Payable
136 Oxygen Cylinder (for Usage outside the Hospital) Not Payable 180 Any Kit with no details mentioned
136 Oxygen Cylinder (for Usage outside the Hospital) Not Payable [Delivery Kit, Orthokit, Recovery Kit, Etc] Not Payable
137 Pulseoxymeter Charges Device Not Payable 180 Any Kit with no details mentioned
138 Spacer Not Payable [Delivery Kit, Orthokit, Recovery Kit, Etc] Not Payable
139 Spirometre Not Payable 181 Examination Gloves Not Payable
140 SPO2 Probe Not Payable 182 Kidney Tray Not Payable
141 Nebulizer Kit Not Payable 183 Mask Not Payable
142 Steam Inhaler Not Payable 184 Ounce Glass Not Payable
143 Armsling Not Payable 185 Outstation Consultant's/ Surgeon's Fees Not Payable, Except For
144 Thermometer Not Payable (paid By Patient) Telemedicine Consultations
145 Cervical Collar Not Payable Where Covered by Policy
146 Splint Not Payable 186 Oxygen Mask Not Payable
147 Diabetic Foot Wear Not Payable 187 Paper Gloves Not Payable
148 Knee Braces ( Long/ Short/ Hinged) Not Payable 188 Pelvic Traction Belt Should be Payable in case of
149 Knee Immobilizer/Shoulder Immobilizer Not Payable PIVD requiring traction as this
150 Lumbo Sacral Belt Essential and should be paid is generally not reused
at least specifically for cases 189 Referal Doctor's Fees Not Payable
who have undergone Surgery 190 Accu Check ( Glucometery/ Strips) Not Payable. Pre-
of Lumbar Spine Hospitilasation or Post-
151 Nimbus Bed or Water or Air Bed Charges Payable for any ICU Patient Hospitalisation / Reports and
requiring more than 3 Days in Charts Required/Device Not
ICU; All Patients with Payable
Paraplegia/Quadriplegia for 191 Pan Can Not Payable
any reason and at Reasonable 192 Sofnet Not Payable
Cost of approximately Rs200/Day 193 Trolly Cover Not Payable
152 Ambulance Collar Not Payable 194 Urometer, Urine Jug Not Payable
153 Ambulance Equipment Not Payable 195 Ambulance Payable - Ambulance from
154 Microsheild Not Payable home to Hospital or inter-
155 Abdominal Binder Essential and should be Paid hospital shifts is Payable/ RTA
at least in Post Surgery As Specific Requirement for
Patients of Major Abdominal critical injury is Payable)
Surgery Including TAH, LSCS, 196 Tegaderm / Vasofix Safety Payable- Maximum of 3 in
Incisional Hernia Repair, 48 Hrs and then 1 in 24 Hrs
Exploratory Laparotomy for 197 Urine Bag Payable where medicaly
Intestinal Obstruction, Liver necessary till a reasonable
Transplant Etc. cost - Maximum 1 Per 24 Hrs
G Items Payable If Supported By A Prescription 198 Softovac Not Payable
199 Stockings Essential for case like CABG
156 Betadine \ Hydrogen Peroxide\spirit\ May be Payable when
etc. Where it should be paid.
Disinfectants Etc prescribed for Patient, Not
Payable for Hospital use in OT
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