Learning Center  /  

Category: General

It is good to be aware of ‘Deductibles’ in your health insurance claim

As per standard industry practice, there are non-payable items in hospital bills under health insurance claims

You should be aware of what is payable and not payable on your hospitalisation claim by your health insurer. All insurers will require an itemised bill for the purpose of processing the claims, whether it is a cashless or a reimbursement claim.

Certain of the items in the bill, charged by the hospital, are not payable by the Insurance Company, as an Industry standard. These non-payable charges in the hospital bill are called ‘Deductibles’.

Common heads of deductibles in a health insurance claim are,

  1. Non-medical Items: During the course of treatment and your stay at the hospital, certain of the non-medical items used will not be payable in an insurance claim. Though the list of defined non-medical items will vary from Insurer to Insurer, the most common ones are
    1. Gloves
    2. Disposable Syringes
    3. Hospital Gown
    4. Cost of Food
    5. Thermometer
    6. Masks
    7. Sanitisers and Toiletries
    8. Consumables like Bandages, cotton, gauze, etc.
    9. Instrumental Charges
    10. Diapers
  2. RMO/Duty Doctor Charges: The Resident Medical Officer/duty doctor charges are not payable as this is expected to be a part of Room Rent and nursing fees.
  3. Hospital Registration or any other administrative fees: Patient Registration Fees or related charges as part of Hospital administration is usually not a part of claim settlement.
  4. Child vaccinations are not payable by Insurance Companies as per the regulation of IRDA.

Apart from the above common deductibles, there will be other non-payable items specific to the ailments for which the treatment is being undertaken.

However, the list of deductibles may vary from Insurer to Insurer based on their internal policies on claims. So, few insurers are likely to be liberal and others strict.