How does Consumables Coverage Work in Health Insurance?

A Guide to Consumables Coverage Mechanism in India

Consumables coverage in health insurance pays for the expenses of non-reusable medical items used in the insured's treatment. Thus, the policyholder does not need to bear additional expenses in paying for the consumables during a hospital stay or treatments.

Policyholders often miss this aspect while purchasing health insurance, but these expenses form a significant part of their medical bill, which can drain their savings. Having a health insurance policy with consumables coverage will cover these expenses, ensuring financial stability and peace of mind.

Keep reading to learn more.

What does Consumables in Health Insurance Include?

"Consumables" usually refer to the medical equipment that is discarded after usage. In a 2016 survey, the IRDAI (Insurance Regulatory and Development Authority of India) reviewed a list of non-payable consumables, which included 199 items. The insurance company can include or exclude any consumables from this list in their health insurance coverage.

Here’s what consumables include in health insurance policies:

1. Room Charges

Items like television, air conditioner, telephone, DVD player, luxury tax, IV injection, attendant charges, etc., in a hospital room are included as consumables.

2. Administrative Charges

Expenses incurred for birth or death certificates, admission kits, visitor's passes, documentation expenses, discharge procedures, daily chart maintenance charges, medical records, etc., are included in consumables.

3. Surgical Items

Items used in surgical procedures, such as syringes, razors, cotton, needles, masks, gloves, sutures, gowns, surgical tape, thermometers, tourniquets, slings, splints, collars, braces, etc., are included in consumables.

4. House-keeping Items

Items such as toothbrushes, mineral water, toothpaste, sanitary pads, slippers, combs, tissue paper, shampoo, belts, powder, caps, baby food, diapers, carry bags, cradles, etc., are included in consumables.

How Consumables Increase Your Medical Bill?

Many patients don’t realise how quickly the cost of consumables can increase their hospital bills. Even a short-term hospital admission includes consumables like gloves, syringes, IV sets, masks, disinfectants, and dressing materials, all billed separately. For routine procedures, these charges may seem small, but they can add to your bills quickly.

Every step in a surgery or complex treatment needs consumables like anaesthesia circuits, surgical drapes, drains, and specialised disposables for monitoring and infection control. If your health insurance policy excludes or limits coverage of consumables, you’ll be paying a lot out of your own pocket, on top of the costs of the room and the procedure itself.

That gap can turn a planned medical expense into a huge financial burden. Checking policy details for consumables coverage and asking hospitals for itemised estimates before admission can help avoid unpleasant surprises.

Why Consumables Coverage in Health Insurance is Important in India?

Here are some of the reasons why buying a health insurance policy with consumable coverage is important:

1. Helps Reduce Out-of-Pocket Expenses

Most health insurance plans do not cover the expenses of non-medical items, increasing the policyholders' out-of-pocket expenses when paying for consumables bills. Buying a health insurance plan with consumables coverage helps reduce these expenses as they are taken care of by the insurance provider.

2. An Exponential Increase in the Price of Consumables

Since the COVID-19 pandemic, the cost of consumables has increased dramatically as a result of widespread use and hospital overcharging. Under such circumstances, policyholders who do not have consumables coverage will have to pay hefty costs out of pocket.

However, individuals with a consumables cover in their health insurance plan can usually enjoy coverage up to the total sum insured limit. Checking the policy terms to understand the consumables cover limits can assist in avoiding unpleasant surprises.

3. Uncompromised Treatment Facility

Many individuals compromise on the quality of their treatment, as most health insurers do not cover the higher consumables expenses charged by the hospitals. Thus, individuals opt for cheaper treatment options to reduce their out-of-pocket expenses for consumables.

Choosing a health insurance policy that includes consumables coverage helps avail quality treatment at an affordable price, as your insurer will pay for these bills.