Consumables and 'non-payable items' deducted from my claim — gloves, masks, kits

A health policy can carry an annexure listing items it does not pay for at all — New India's Arogya Sanjeevani wording, for example, lists gloves, masks, kits with no details and toiletries — and other items it treats as part of the room, procedure or treatment charge rather than as separate lines. If your annexure lists the item, the deduction has a basis in your policy. It is worth questioning if the item is not listed, if it was a prescribed medicine, or if you bought an optional cover for consumables.

Here is how one wording organises it. New India's Arogya Sanjeevani policy says the "expenses that are not covered in this policy are placed under List-I of Annexure-A", and the items to be "subsumed into room charges, or procedure charges or costs of treatment" are in Lists II, III and IV.^[1]

Whatever the list says, it has to be in your policy. IRDAI's 2024 master circular says all applicable exclusions must be in the policy document, and no deduction may be made "in the name of any other exclusions".^[2]

What the four lists mean

So an item from Lists II to IV is not "excluded" in the same way as a List I item: the policy treats its cost as already inside a bigger charge. If the hospital billed it as a separate line, expect that line to be deducted, and check that the bigger charge it belongs to was paid.^[1]

Deductions worth questioning

• An item that is on none of the lists: Ask which clause the insurer relied on; a partial disallowance must refer to the specific policy terms.^[3]
• A prescribed medicine treated as a toiletry: The same list excludes creams, powders and lotions as toiletries, but adds "only prescribed medical pharmaceuticals payable". Check the prescription.^[1]
• A "kit" that does have details: List I names "ANY KIT WITH NO DETAILS MENTIONED". If the hospital's itemised bill shows what was in the kit, ask for it and send it.^[1]
• An optional cover you paid for: The circular asks insurers to classify, where possible, "Exclusions which can be opted for cover by paying additional premium". Check your schedule for a consumables add-on before accepting the cut.^[2]

How to raise it

1. 1

   Put the bill beside the deduction sheet

   Mark each consumables line on the bill and the matching deduction. See reading the deduction sheet.

2. 2

   Note the list and item number

   For each deduction, write which list in your annexure it falls in, or "not listed".

3. 3

   Write once, with every line you question

   An insurer should resolve a complaint within 14 days and give reasons that refer to the policy terms if it does not accept it.^[2]

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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