This health insurance add-on can save you up to 18% on extra medical costs!

Geeta thought she was prepared when her mother underwent surgery at a well-known hospital in Delhi. With a health insurance cover of Rs 5 lakh, she felt reassured that the expenses would be taken care of. However, when her insurer approved only Rs 3.8 lakh out of the total Rs 4.5 lakh bill, Geeta was left stunned. The unexpected shortfall of Rs 70,000 came as a blow, especially when she realised that the exclusions in her policy — particularly for 'consumables' like PPE kits, syringes, and gloves — were responsible for the gap.

"It was quite a shock when I saw the breakdown. I thought I had everything covered, but then I saw all these items that weren't included. I had no choice but to pay out of my own pocket," Geeta shared.

 

Geeta’s experience shows just how important it is to understand the potential hidden costs in health insurance. Policyholders can easily be caught off guard by expenses, especially when they aren’t fully aware of what their policy actually covers.

What are consumables in health insurance?

The issue stems from consumables — everyday medical items used during hospitalisation, such as gloves, syringes, and bandages. These items, although necessary, are often not included in standard health insurance policies.

"Consumables in health insurance refer to medical items that are used up or destroyed during treatment," explains Rakesh Jain, CEO of Reliance General Insurance. "These items, while essential, are not usually covered by standard policies, leading to unexpected out-of-pocket costs for patients."

Covid-19 pandemic

In 2016, the Insurance Regulatory and Development Authority of India (Irdai) listed 199 consumables that most insurers do not cover, giving insurance companies the discretion to exclude these items from their policies.

Before the Covid-19 pandemic, consumables accounted for just 3-5% of hospital bills, a manageable amount. But after the pandemic, this figure skyrocketed, largely due to the need for PPE kits and other disposable items used during treatment.

To address this increase, many insurers are now offering Consumables Cover as an add-on to their regular health plans. "A consumables add-on provides coverage for these non-medical items, significantly reducing the financial burden on the insured," says Jain. "Some insurers include this coverage as part of their base health policy, while others offer it as an optional rider."

Bajaj Allianz General Insurance and Reliance General Insurance are among the companies offering consumables cover. According to Bhaskar Nerurkar, Head of Health Administration at Bajaj Allianz General Insurance, "We offer consumable expense cover with certain products, either as part of the policy or as an optional add-on, depending on the plan."

Reliance General Insurance provides similar protection through an add-on cover, allowing policyholders to include consumables in their claims.

Is a consumables cover worth considering?

For families facing medical emergencies, the financial strain of paying for consumables out of pocket can be overwhelming. "Consumables make up around 11-18% of the total bill, and without a consumables cover, you’re left to handle those costs yourself. During a medical emergency, this can add unnecessary stress," explains Siddharth Singhal, Head of Health Insurance at Policybazaar.

Things to consider when buying health insurance

* Waiting periods for pre-existing diseases are common, so purchasing insurance early can help. Consider buying a PED reduction rider to reduce this waiting time.

* Plastic surgeries and transmitted diseases like AIDS and HIV are generally not covered.

* Corporate health insurance policies often do not include consumables cover unless specifically added.

Singhal also points out that corporate health insurance plans may not include a built-in consumables cover, but it can be opted for as an add-on.

Health insurance plans offering consumables cover

Here’s a look at some health insurance plans with consumables add-on options:

Care Health, Care Supreme: Premium of Rs 10,479, with a consumables rider costing Rs 452

Coverage amount: Rs 25 lakh

Niva Bupa, Reassure: Premium of Rs 9,277, with a consumables rider costing Rs 881

Coverage amount: Rs 25 lakh

Aditya Birla, Active One: Premium of Rs 7,273, with a consumables rider costing Rs 436

Coverage amount: Rs 10 lakh

ICICI, Elevate: Premium of Rs 7,428, with a consumables rider costing Rs 345

Coverage amount: Rs 10 lakh

Star Health, Smart Health Pro: Premium of Rs 5,414, with a consumables rider costing Rs 406

Coverage amount: Rs 10 lakh

What is covered under a consumables add-on?

A consumables add-on typically includes:

Administrative charges: Documentation, admission kits, medical record maintenance, etc.

Surgical equipment: Gloves, masks, cotton, needles, gowns, and other disposable items.

Room expenses: AC, TV, telephone, and attendant charges.

Housekeeping items: Toothbrushes, shampoos, tissue paper, slippers, and more.