The "Gloves & Masks" Shock: Reviewing & Fixing It

y2jmoneytree
Mar 24
3 min read

The Discharge Day Surprise

Picture this: Your family member is recovering in the hospital after a successful surgery. The stress is fading. The insurance company sends an SMS: "Cashless Claim Approved for ₹3,00,000." You breathe a sigh of relief.

But when you reach the billing desk to get the discharge summary, the receptionist hands you a bill for ₹38,000.

"But my claim was approved!" you argue.

"Yes sir," she replies politely. "The surgery is paid for. This ₹38,000 is for Non-Medical Expenses - gloves, masks, registration fees, and kits. Insurance doesn't cover this."

This scenario plays out in hospitals every single day. We assume "Comprehensive Health Insurance" means the insurer pays for everything inside the hospital walls. Unfortunately, the fine print says otherwise.

Today, let’s decode the mystery of Non-Medical Expenses (NME) or Consumables.

What Are "Consumables"?

As defined by the Insurance regulator of India - IRDAI (Insurance Regulatory and Development Authority of India), hospital expenses are divided into two buckets:

Medical Treatment: Doctor fees, room rent, medicines, and surgery costs (Insurers pay this).
Consumables: Items that are "used and thrown" or used for administrative purposes. (Insurers traditionally exclude this).

The "Restaurant" Analogy

Think of it like ordering a takeaway thali.

The Insurance pays for the Paneer, Dal, and Roti (The Treatment).
But they refuse to pay for the plastic container, the spoon, the tissue paper, and the delivery bag (The Consumables).

It sounds petty, right? But in a hospital, these "plastic containers" cost thousands of Rupees.

What Do You Usually Pay For?

You might think, “How much can cotton and gloves cost? It shouldn't be that much”.

In reality, it costs a lot. Especially since hospitals often mark up these items. Here is a list of common items that usually come out of your pocket:

Administrative: Admission charges, Registration fees, Medical Record charges.
Housekeeping: Mineral water, extra beds for attendants, and laundry charges.
Medical Consumables: Syringes, needles, gloves, masks, nebulizer kits, oxygen masks, and thermometers.

This Is a Bigger Problem Post-COVID

Before 2020, consumables made up about 3% to 5% of a hospital bill. Most Indians ignored it as "small change".

However, the pandemic changed hospital protocols. Hygiene standards skyrocketed. The use of PPE kits, N95 masks, and frequent sanitization became mandatory. Today, consumables can easily make up 10% to 15% of your total bill.

Fact: On a bill of ₹10 Lakhs for a critical illness, the non-payable component can be as high as ₹1-1.5 Lakhs. That is the price of a small vacation, wiped out in minutes!

The List is longer

IRDAI has pre-defined this list of "Consumables" and how to categorize them. There are 4 lists under this category:

List I : 68 (Optional Items)

List II : 37 (to be part of Room Charges)

List III : 23 (to be part of Procedures)

List IV : 18 (to be part of Treatment)

Refer to the IRDAI lists here: https://irdai.gov.in/document-detail?documentId=392476

As a client of an insurance company, you need to be aware of whether "Consumables" are part of your coverage and which lists are included in the policy.

Frequently asked questions

Q: Why do insurers exclude these items in the first place?
A: Historically, it was hard to track the usage of gloves/cotton per patient, leading to billing fraud. Excluding them was an easy way for insurers to control costs.
Q: Is there a way to include these "Consumables" in my policy?
A: Yes! If your insurer offers this "Add-On," check whether your policy already includes it. Very old policies may not have it added. Otherwise, if you are considering "porting" your policy to a new product or a company, ensure that it's included for a marginal price difference.

Conclusion

When you or a loved one is in the hospital, your focus should be on recovery, not on arguing with the billing department about the price of a nebulizer mask.

Health cover is a powerful tool, but like any powerful tool, it works best when you: