Does your health insurance cover consumables? Understand the importance

‘Health insurance provides coverage for medical expenses’ – the keyword in this sentence is ‘medical.’ 

At the time of discharge, even if you get treated at a network hospital, you may have to pay out-of-pocket for non-medical expenses. For example, the insurer does not pay for items like gloves, syringes, toothbrushes, sanitary pads and administrative charges.

These consumables are typically not included in health insurance plans. Without additional consumables, you will have to cover these expenses on your own.

 The article will go through consumables and the benefits of investing in a consumable cover in health insurance.

What is the meaning of consumables?

Consumables are items used during treatment but discarded after use. For example, once a bandage is used to dress a wound, it must be discarded when the dressing is changed. During COVID, PPE kits were discarded after a single use.

The IRDAI has defined several categories that comprise the hospital bills consumables list. Examples of these categories are toiletries, room charges, and administrative and external durable devices.

Why are consumables typically not included in health insurance?

Consumables are single-use items, which is one of the biggest reasons regular health plans do not cover them. For example, if you have a major surgery or are hospitalised for a long duration, consumables could make up a significant part of the hospital bill.

Studies and investigations have shown that consumables are a major profit source for hospitals. And the use of these consumables is unavoidable. For these reasons, health insurance companies mention the list of consumables items under their exclusion category.

What is a consumables cover in health insurance?

In the pre-COVID era, consumables accounted for 3 to 5% of hospital bills. When your health insurance covers 95 to 97% of your medical expenses, paying the comparatively smaller consumables bill may not seem like much.

However, consumables account for up to 10%-20% of hospital bills post-COVID. This is a significant increase that can financially burden policyholders.

Insurance companies have come up with health insurance consumables cover to overcome this financial challenge and help policyholders.

You can buy the consumables cover as an add-on to your health insurance. The additional premium can save you from paying a significant portion of your bill out-of-pocket.

What is included in the consumables items list?

IRDAI has released a list of 199 items that are not covered by insurers. A consumables add-on with your health insurance, though, can help cover the cost of some of these items.

The consumables list is divided into four main categories as below:

• Surgical items: Any single-use medical equipment or items required for treatment or surgery are included in this category. Examples of surgical items include gloves, masks, PPE kits, cotton, syringes, surgical tape, bandages, and razors.
• Administrative charges: Once you are hospitalised, several documents are generated; the cost for them is part of the consumables list. These include the admission kit, patient file, medical records, visitor pass, daily charts, and discharge summary.
• Housekeeping items: This category includes items for daily use and convenience, such as toothbrushes, toothpaste, sanitary pads, mineral water, gowns, and slippers.
• Room charges: Depending on the room type, you may have facilities like telephone, television, AC, and internet. These facilities are not payable by the insurer unless you have a consumables cover. 

Please note the IRDAI list is used as a guideline. The insurer may include/exclude consumables items in their health products according to their terms. So, go through the list of consumables items included when buying the add-on cover.

Why should you buy a health insurance consumables cover?

Here are the benefits of buying a consumable cover in health insurance.

• You are protected against hefty consumables bills. The cover can significantly cut down on out-of-pocket expenses.
• The additional premium that you pay for the consumable cover is a pocket-friendly decision that can save you from financial stress in the future.
• Insurance companies are required to state in the policy document what consumables are included or excluded. So, the policyholder has complete transparency.

Key Takeaways

A general health insurance product does not cover the cost of consumables. Gloves, masks, gowns, surgical tape, cotton, and bandages are some examples of consumables items.

You will pay out-of-pocket for these non-medical expenses, which can be a considerable financial burden.

A health insurance consumables cover can provide protection against such expenses. It can help reduce out-of-pocket costs and make healthcare affordable. PhonePe helps you discover health insurance options that include consumables cover, ensuring comprehensive protection and affordability.