The IRDAI Non-Payable List: 68 Items on Your Hospital Bill That Insurance Won't Pay

When a hospital sends its bill, some lines are ones your insurer treats as non-payable: it will not reimburse them even when your claim is approved. IRDAI, the insurance regulator, has a standard list of these items, and insurers print it with their policy documents.

ICICI Lombard, for example, publishes a document called "List of Non Payable Items as per IRDAI" for its retail health plans: Complete Health Insurance, Healthcare Plus, Health Booster and Arogya Sanjeevani. It has 68 numbered items. The same document says the list may be updated as per the direction of the Authority. So the list that counts is the one in your own policy documents, for the date of your admission.

We read that list line by line and sorted it into five groups.

Personal comfort and convenience (18 items): baby food, baby utilities charges, beauty services, carry bags, email or internet charges, food other than the patient's diet provided by the hospital, leggings, laundry charges, mineral water, sanitary pads, telephone charges, guest services, diapers of any type, television charges, attendant charges, extra diet of the patient (other than what forms part of the bed charge), sugar-free tablets, and creams, powders and lotions. For that last one the list says toiletries are not payable, only prescribed medical pharmaceuticals are.

Paperwork and administration (7 items): birth certificate, certificate charges, courier charges, conveyance charges, medical certificate, medical records and photocopy charges.

Extra service charges (5 items): service charges where a nursing charge is also charged, surcharges, mortuary charges, nimbus, water or air bed charges, and private nurses' (special nursing) charges.

Supports, braces and walking aids (16 items): belts and braces, cold or hot packs, crepe bandages, eyelet collar, slings, walking aids charges, arm sling, cervical collar, splint, diabetic foot wear, knee braces (long, short or hinged), knee or shoulder immobilizer, lumbo-sacral belt, ambulance collar, abdominal binder and pelvic traction belt.

Small equipment and consumables (22 items): buds, blood grouping and cross matching of donor samples, oxygen cylinder for use outside the hospital, spacer, spirometer, nebulizer kit, steam inhaler, thermometer, ambulance equipment, ECG electrodes, gloves, nebulisation kit, kidney tray, mask, ounce glass, oxygen mask, pan can, trolley cover, urometer or urine jug, ambulance, vasofix safety, and any kit with no details mentioned (delivery kit, orthokit, recovery kit and so on).

A claim can be approved, and a cashless request authorised, and the final bill can still contain lines from this list. Those lines are yours to pay. The longer the stay and the more procedures, the more of them appear.

The list does not set any amount. What each item costs depends on the hospital. As an illustration with made-up numbers: if a bill has 20 lines from this list at an average of ₹300, that is ₹6,000 you pay yourself, although the treatment itself is covered. Your own bill will differ.

Item 58 on the list is "any kit with no details mentioned", with delivery, ortho and recovery kits as examples. That means a kit billed as a single line, with no list of what is inside, is non-payable. If your bill has a kit line, ask the hospital to itemise what it contains. Whether the contents are then payable is for your insurer to decide under your policy.

Find your policy's own list. It is part of your policy documents. Read it once before you need it.

Ask for an itemised bill before you leave. Check kits and "charges" lines, and ask the billing desk about anything you do not recognise.

Expect to pay the comfort items yourself. Food for visitors, telephone, television, laundry and guest services are on the list whichever plan you hold.

Check whether your plan mentions consumables. Of the 335 plans on FinResp, 47 mention consumables in their benefits, add-ons or coverage notes. That is a mention, not a promise: read exactly how your plan words it, and what it covers and what it does not.

This article is based on one insurer's printed copy of the list, which it describes as the IRDAI list. We have not compared it with IRDAI's current circular, and other insurers' copies may differ in length and wording. If a line on your bill is not on your own policy's list and your insurer deducts it, ask the insurer in writing which clause it relied on.

This is information, not advice.