NON-ADMISSIBLE EXPENSES effective 24.11.

2009
Sl. No
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Category of
Expenses Not Admissible
Expenses
Room Charges Additional Room charges / bed charges for attendant
Related
Attender Bed Charges
Excess of ICU & Nursing Charges per Day
Excess of ICU & Nursing Charges for Additional Day Charged by Hospital
Excess of ICU/ Normal Ward with Nursing Charges in excess of 25% of Sum Insured
Excess of Room Rent & Nursing Charges for Additional Day Charged by Hospital
Excess of Room Rent & Nursing Charges Limit per day
Excess of Room Rent & Nursing Charges beyond 25% of SI per Hospitalisation/ Illness
Investigation
Charges
Related

Professional
Charges
Related

Excess of Investigation Charges for the Eligible Category of Room Rent & Nursing Charges
Expenses for investigation/ Treatment irrelevant to the disease for which admitted or diagnosed
Investigation Charges for CAG where no CAG Report received
Investigation Charges in Main Bill where no reports received
Investigation Charges included already in Main Hospital Bill
Investigation Charges not related to the Diagnosis
Investigation Reports for Bio-Chemistry not received
Investigation Reports for Hematology not received
Investigation Reports for Micro-Biology not received
Investigation Reports for Radiology (X-ray/ MRI/ CT/ ECG) not received
Investigation Reports for Urine not received
Lab Charges for Reports not Enclosed
Anesthetist Charges disproportionate to Surgeon's fee
Dietitian Charges
Excess of Professional Charges for the Eligible Category of Room Rent & Nursing Charges
Excess of Professional Charges paid outside the Hospital Main Bill in excess of 25% of SI
where it is paid by cheque
Excess of Professional Charges paid outside the Hospital Main Bill in excess of 10% of SI
where it is paid by cash
Excess of Proportionate Professional Charges for the Eligible Category of Room Rent &
Nursing Charges
Excess of Sub-limit of 25% for Ayurvedic/ Unani/ Homeopathic Treatment
Excess of Sub-limit of 25% for Professional Charges
Excess of Sub-limit of 50% for Charges other than Room Rent & Professional Charges
Injection Charges (as Nursing Charges included in Room Charges)
IV Fluid Infusion Charges (as Nursing Charges included in Room Charges)
MLC Doctor Charges
Multiple Consultation Charges not related to Diagnosed Ailments
Nursing Charges as Maximum Charges allowed under Room Rent
Opinion Charges
Outstation Consultant's/ Surgeon's Fees in excess of the Hospital Tariff charges
Preparation Charges
Private Nurses Charges- Special Nursing Charges

Remarks

Sl. No

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Category of
Expenses

Maternity
Related
Charges

Hospital
Charges

Expenses Not Admissible

Psychiatric Consultation Charges
Referral Doctor's Fees
Ante-natal Consultation Charges
Ante-natal Expenses
Ante-natal Expenses without Hospitalisation (wherever Maternity is covered)
Anti-D / Rhoclone etc Immunisation for RH Negative Mother Carrying RH Positive Baby
Baby Bottles
Baby Food
Baby Powder
Baby Set
Birth Certificate
Maternity related Consultations
Maternity related Expenses
Post-natal Consultation Charges
Post-natal Expenses
Post-natal Expenses without Hospitalisation (wherever Maternity is covered)
Pre-natal Consultation Charges
Pre-natal Expenses
Pre-natal Expenses without Hospitalisation (wherever Maternity is covered)
Vaccine Charges for Baby
AC Charges
Admission fee
Advance Amount Paid
Ambulance Charges exceeding the Policy Limit
Ambulance - Transport charges
Attendant / Ayah / Ward boy Charges
Barber charges
Beauty Services
Body Wash
CD / DVD/ Video cassette Charges
Commode Charges
Daily Chart Charges
Diabetic Chart Charges
Documentation Charges / Administrative Expenses
Donor Screening Charges
Email / Internet Charges
Electricity Charges (levied by Hospital)
Entrance Pass / Visitors Pass Charges
Establishment Charges
File Charges
File Opening Charges

Remarks

Payable only in first pregnancy provided Gravida status is L- o. If

it is L-1 not payable.

Payable under Certain Policies - Pl Check the policy

Payable only if the Policy specifically covers

Payable under certain policies - Within the terms and conditions

of the insurance policy

Sl. No

Category of
Expenses

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Expenses Not Admissible

Gate Pass Charges
Guest Services
Home Nursing Charges
Home Visit Charges
Incidental Expenses / Misc. Charges (Not Explained)
Insurance Processing Charges
Laundry Charges
Luxury Tax
Medical Certificate
Medical Record Charges
Medico Legal Charges / MLC Charges
Mortuary Charges
Nutrition Planning Charges
Patient Identification Band / Name Tag
Photocopy Charges
Registration Charges / Fee

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Service Charges Where Nursing Charge also Charged
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Surcharges
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Telephone Charges
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Television & Air Conditioner Charges
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Washing Charges
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Water Charges (levied by Hospital)
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X-ray Film
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Aesthetic Treatment/ Surgery
Therapies/
Treatments not Hormone Replacement Therapy
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Admissible
under the
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Infertility/ Sub-fertility/ Assisted Conception Procedure
Policy
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Naturopathy Treatment Charges
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Non-allopathic Treatment Charges
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Stem Cell Implantation/ Surgery
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Weight Control Programs/ Supplies/ Services
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Yoga Charges
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Ailment Related Any Expenses when the patient is diagnosed Retro Virus + or suffering from /HIV/ Aids etc is
detected
Expenses
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Dental Treatment Expenses that do not require Hospitalisation
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Obesity ( Including Morbid Obesity) Treatment
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Psychiatric & Psychosomatic Disorders - treatment charges
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Sexually Transmitted Diseases - treatment
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Surgery for Correction of Eye Sight like Myopia/ Hypermetropia/ Ambliopia/ Presbiopia/
Astigmatism/ Strabismus etc.,
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Consumables

Accucheck
Alex Sugar Free

Remarks

Payable under Certain Policies. If Admission Charges admitted

this cannot be admitted.

Hospitalisation exclusively for Hormonal Replacement Therapy

not warranted - Not payable

Payable only under Policies where PED is covered by way of

Deletion of the Exclusion or by way of entitlement after lapse of
specified period of claim free duration

Sl. No

Consumables
Category of
Expenses

Expenses Not Admissible

Remarks

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Apron / Drape / Linen

Band Aid
Bandages
Betadine \Scrub solution \Hydrogen Peroxide\Spirit\Sterillium \ Dettol etc - charges in excess

If it is disposable one, to allow

Not payable - Part of Dressing Charges
Not -payable - Part of Dressing Charges
Reasonable Amount not Exceeding Rs. 100 allowable

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Blade
Clean sheet
Cliniplast
Cotton

Surgical Blades are payable in case of Surgery

Disposable items that cannot be reused will be payable

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Cotton Bandage

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Cozy sheet/cozy towel

Crepe bandage

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Curapore/ Micropore - Adhesive Bandage

Diaper
Diegene Gel
Drapes
Eau-de-Cologne / Room Fresheners
Examination Gloves - in Excess

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Eye Drape
Eyelet Collar
Eye Pad
Eye Shield
Foot Cover
Gauze

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Gauze Soft

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Gels - Volini/ Zytee

Gloves - Sterile (For Surgery)
Glucometer/ Gluco Strips/ Accu Check etc
Gown
Hand Holder
Hand Rub
Hand Wash
Leggings
Loban
Lotions
Mask / Face Mask/ Flexi Mask
Medicine Box
Microshield

In case of open wound And post-Operative infected wounds payable if Dressing charges are not charged in the bill
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
Payable only in case of Varicose Vein Surgery/ Accident with
open wounds
Not payable - Part of Dressing Charges
Payable only when prescribed
Disposable items that cannot be reused will be payable
Payable up to 15 No. in case of Surgery & two gloves per day for
open wound when dressing charge is not charged
Disposable items that cannot be reused will be payable
Disposable items that cannot be reused will be payable
Payable in case of eye surgery
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
In case of open wound And post -Operative infected wounds payable if Dressing charges are not charged in the bill
Payable only if prescribed for medicinal use
To allow - 10 in general and 25 in case of surgery

Payable only if prescribed for medicinal use

Payable only if prescribed for medicinal use

Sl. No

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Category of
Expenses

Durable Items
Not Allowable

Expenses Not Admissible

Micropore
Mineral Water
Napkins/ Towels
Nebulisation Mask
Novarapid
One Touch Sure Strip
Ortho bundle, Gynaec Bundle
Ounce Glass
Oxygen Mask
Pads
Pan Can
Paper gloves
Plain Sheet
Resource Powder
Sanitary Pad / Sanitary Napkins
Shoe Cover
Slippers
Soap, Powder, Shampoo and other Toiletries
Sofnet
Softovac
Spacer
Specimen Bottle
Spirometer
Splint
SPO2 Probe
Sputum Cup
Steam Inhaler
Stockings
Surgical Blades,Harmonic Scalpel,Shaver
Surgical Drill
TED Stockings\ Stockings
Thermometer
Trolley Cover
Under Pads
Abdominal Belt / Binder
Abdominal Drain Kit
Alpha bed/ water bed etc
Ambulance Collar
Ambulance Equipment
Ambulatory Devices like Walker/ Crutches / Wheel Chair, etc.,
Arthroscopy & Endoscopy Instruments
CPAP/ CAPD Equipments

Remarks

Payable when specifically prescribed

Payable when specifically prescribed

Disposable items that cannot be reused will be payable

Only rental charged by the hospital allowed. Purchase of

Instruments not allowed.
Hospital Rental only payable

Sl. No

Category of
Expenses

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Expenses Not Admissible

Infusion Pump - Cost
Instrument Charges where no details of procedure/ Instrument used is given
Oxygen Cylinder (for usage outside the hospital)

Re-usable
Items

Toiletry Items

Kits

Arm sling
Bed Pan
Belts
Blanket/warmer blanket
Bottles
Braces
Brush
Camera Cover
Caps
Cervical Collar
Cold pack/hot pack
Collars
Cost of Spectacles/ Contact Lenses/ Hearing Aids etc.,
Diabetic Foot Wear
Kidney Tray
Knee Braces ( long/ short/ hinged)
Knee Immobilizer/Shoulder Immobilizer
Lumbo Sacral Belt
Microscope Cover
Pelvic Traction Belt
Rib Binder/ Abdomen Binder
Slings
Spectacles
Tourniquet
Urine Can/ Urine Jug/ Urine Container
Urometer
Comb
Cosmetics
Creams
Moisturiser / Paste / Brush
Mouth Paint
Mouth Washes like Listerene
Tissue Paper
Tooth Brush
Tooth Paste
Towel
Admission kit

Remarks
Hospital Rental only payable
In case of Post-hospitalisation expenses, cost of Oxygen
prescribed payable but not the cost of the cylinder

Payable up to 5 Nos - if disposable one payable in case of Surgery

Payable only if prescribed for medicinal use

Payable when specifically prescribed
Payable when specifically prescribed

Sl. No
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Category of
KitsExpenses

Any Kit with no details mentioned [Delivery kit, Ortho-kit, Recovery kit, etc]

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Expenses Not Admissible

Eye Kit
Hernia Kit

Dis-allowable
Expenses

HIV Kit
Nebulizer Kit
Amount claimed already paid under Cashless Claim
Amount Paid by the Patient
Bills Beyond Permitted Post-hopsitalisation Period
Bills Beyond Permitted Pre-hopsitalisation Period
Bills in the Name other than the Insured Patient
Bills not in Proper Format/ not Serially Numbered & Printed Bill
Charges paid to organ donors
Concession Given by the Hospital
Co-pay
Credit Bills - No Cash Paid Receipt
Discount Agreed with TPA by the Hospital
Discount Given to the Insured
Duplicate Bills
Excess of Agreed Package Rate
Excess of Limit per Hospitalisation
Excess of OT Charges for the Eligible Category of Room Rent & Nursing Charges
Excess of Reasonable, necessary & Customary Charges
Expenses exceeding Pre-hospitalisation Limit
Expenses exceeding Post-hospitalisation Limit
Expenses related to Prescription on Discharge
Health Drinks - Horlicks, Viva Bournvita & Protein Powder including Lactogen
Hospitalisation for Evaluation/ Diagnostic Purpose
Miscellaneous - Details not furnished
No Bills for claimed amount
Policy Excess

Remarks
To find out the contents of the Kit and if they are medically
required, payable
Disposable items that cannot be reused will be payable
To find out the contents of the Kit and if they are medically
required, payable
Payable when specifically prescribed

Not Payable under Cashless Claim

Admissible only to the extent prescribed