Health Insurance

The insurance regulator has stated 199 basic items for which patients would now have to pay from their pockets

Medical-Policy-BThe guidelines on ‘standardisation in health’ list various standard expenses that would be excluded from hospitalisation indemnity policies, or reimbursement health insurance plans through which insurers pay the insured for treatment costs.

The insurance regulator has stated 199 basic items for which patients would now have to pay from their pockets, while receiving hospital treatment. For instance, insurers wouldn’t pay for basic charges such as baby/infant food, cold/hot packs, water, telephone, bandage, antiseptic lotion, cotton, etc.

Sanjay Dutta, head (customer service) at ICICI Lombard, says these expenses usually account for five per cent of the total treatment cost. Expenses that have been excluded are called consumable expenses, as these are accounted for by toiletries, cosmetics and personal comfort items.

On whether insurers paid for these expenses earlier, Mukesh Kumar, head (strategy), HDFC ERGO, said when it came to paying consumable expenses, interpretation issues were always involved.

Don’t be surprised if insurers launch policies or add-on covers that would cover ‘consumable expenses’. Krishnamoorthy Rao, managing director and chief executive, Future Generali Health, says if the industry launches plans that cover such expenses, these would come at a cost. “Covering the excluded items/expenses will increase our claim cost, which will naturally result in a premium increase. However, at this point, deciding the quantum of premium increase is difficult,” he said.

Divya Gandhi, head (general insurance) and principal officer at Emkay Insurance Brokers, says through such plans, insurers get a chance to increase their premiums, on the back of bleeding portfolios. “Earlier, too, consumables were not paid. But people who approached the ombudsman or the grievance cell got reimbursements on these expenses, as until then, there were no guidelines on these expenses,” she said.

However, a few guidelines would help the insured. For instance, the Insurance Regulatory and Development Authority has clarified certain concepts in health insurance, standardised pre-authorisation and claim forms, which would go a long way in helping policyholders.

For your ready reference, please find attached the 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)

Categories: Health Insurance

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