List I – Items for which coverage is not available in the Policy
Sr. No. |
Item |
| 1 | Baby Food |
| 2 | Baby Utility Charges |
| 3 | Beauty Services |
| 4 | Belt/Braces |
| 5 | Buds |
| 6 | Cold Pack/ Hot Pack |
| 7 | Carry Bags |
| 8 | Email/ Internet Charges |
| 9 | Food Charges (Other than patient's diet provided by hospital) |
| 10 | Leggings |
| 11 | Laundry Charges |
| 12 | Mineral Water |
| 13 | Sanitary Pad |
| 14 | Telephone Charges |
| 15 | Guest Services |
| 16 | Crepe Bandage |
| 17 | Diaper Of any type |
| 18 | Eyelet Collar |
| 19 | Slings |
| 20 | Blood Grouping and Cross Matching of Donors Samples |
| 21 | Service charges where nursing charge also charged |
| 22 | Television Charges |
| 23 | Surcharges |
| 24 | Attendant Charges |
| 25 | Extra diet of patient (Other than that which forms part of bed charge) |
| 26 | Birth Certificate |
| 27 | Certificate Charges |
| 28 | Courier Charges |
| 29 | Conveyance Charges |
| 30 | Medical Certificate |
| 31 | Medical Records |
| 32 | Photocopies Charges |
| 33 | Mortuary Charges |
| 34 | Walking AIDS Charges |
| 35 | Oxygen Cylinder (For usage outside the hospital) |
| 36 | Spacer |
| 37 | Spirometre |
| 38 | Nebulizer Kit |
| 39 | Steam Inhaler |
| 40 | Armsling |
| 41 | Thermometer |
| 42 | Cervical Collar |
| 43 | Splint |
| 44 | Diabetic Foot Wear |
| 45 | Knee Braces ( Long/ Short/ Hinged) |
| 46 | Knee Immobilizer/Shoulder Immobilizer |
| 47 | Lumbo Sacral Belt |
| 48 | Nimbus Bed or Water or Air Bed Charges |
| 49 | Ambulance Collar |
| 50 | Ambulance Equipment |
| 51 | Abdominal Binder |
| 52 | Private Nurses Charges - Special Nursing Charges |
| 53 | Sugar Free Tablets |
| 54 | Creams Powders Lotion (Toiletries are not payable, only prescribed medical pharmaceuticals payable) |
| 55 | ECG Electrodes |
| 56 | Gloves |
| 57 | Nebulization Kit |
| 58 | Any kit with no details mentioned (Delivery kit, Orthokit, Recovery kit, etc) |
| 59 | Kidney Tray |
| 60 | Mask |
| 61 | Ounce Glass |
| 62 | Oxygen Mask |
| 63 | Pelvic Traction Belt |
| 64 | Pan Can |
| 65 | Trolly Cover |
| 66 | Urometer, Urine Jug |
| 67 | Ambulance |
| 68 | Vasofix Safety |
List II – Items that are to be subsumed into room charges
Sl No. |
Item |
| 1 | Baby Charges (Unless Specified/ Indicated) |
| 2 | Hand Wash |
| 3 | Shoe Cover |
| 4 | Caps |
| 5 | Cradle Charges |
| 6 | Comb |
| 7 | EAU-DE-COLOGNE / Room Freshners |
| 8 | Foot Cover |
| 9 | Gown |
| 10 | Slippers |
| 11 | Tissue Paper |
| 12 | Tooth Paste |
| 13 | Tooth Brush |
| 14 | Bed Pan |
| 15 | Face Mask |
| 16 | Flexi Mask |
| 17 | Hand Holder |
| 18 | Sputum Cup |
| 19 | Disinfectant Lotions |
| 20 | Luxury Tax |
| 21 | HVAC |
| 22 | House Keeping Charges |
| 23 | Air Conditioner Charges |
| 24 | Im Iv Injection Charges |
| 25 | Clean Sheet |
| 26 | Blanket/ Warmer Blanket |
| 27 | Admission Kit |
| 28 | Diabetic Chart Charges |
| 29 | Documentation Charges/ Administrative Expenses |
| 30 | Discharge Procedure Charges |
| 31 | Daily Chart Charges |
| 32 | Entrance Pass/ Visitors Pass Charges |
| 33 | Expenses related to prescription on discharge |
| 34 | File Opening Charges |
| 35 | Incidental Expenses/ Misc. Charges |
| 36 | Patient Identification Band/ Name Tag |
| 37 | Pulseoxymeter Charges |
List III – Items that are to be subsumed into Procedure Charges
Sl No. |
Item |
| 1 | Hair Removal Cream |
| 2 | Disposables Razors Charges (for site preparations) |
| 3 | Eye Pad |
| 4 | Eye Shield |
| 5 | Camera Cover |
| 6 | DVD, CD Charges |
| 7 | Gause Soft |
| 8 | Gauze |
| 9 | Ward and Theatre Booking Charges |
| 10 | Arthroscopy & Endoscopy Instruments |
| 11 | Microscope Cover |
| 12 | Surgical Blades, Harmonic Scalple, Shaver |
| 13 | Surgical Drill |
| 14 | Eye Kit |
| 15 | Eye Drape |
| 16 | X-Ray Film |
| 17 | Boyles Apparatus Charges |
| 18 | Cotton |
| 19 | Cotton Bandage |
| 20 | Surgical Tape |
| 21 | Apron |
| 22 | Torniquet |
| 23 | Ortho Bundle, Gynaec Bundle |
List IV – Items that are to be subsumed into cost of treatment
Sl No. |
Item |
| 1 | Admission/ Registration Charges |
| 2 | Hospitalisation for Evaluation/ Diagnostic Purpose |
| 3 | Urine Container |
| 4 | Blood Reservation Charges and Ante Natal Booking Charges |
| 5 | BIPAP Machine |
| 6 | CPAP/CAPD Equipment |
| 7 | Infusion Pump |
| 8 | Hydrogen Peroxide/ Spirit/ Disinfectants etc |
| 9 | Nutrition Planning Charges - Dietician Charges - Diet Charges |
| 10 | HIV Kit |
| 11 | Antiseptic Mouthwash |
| 12 | Lozenges |
| 13 | Mouth Paint |
| 14 | Vaccination Charges |
| 15 | Alcohol Swabes |
| 16 | Scrub Solution/ Sterillium |
| 17 | Glucometer Strips |
| 18 | Urine Bag |
