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It is advisable to go for health insurance policies that do not have sub-limits. But if you opt for one make sure how it works so that that you don’t run into trouble at the time of claim settlement
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Many health insurance policies come with a room rent limit. This often becomes a point of contention as people are caught off guard about this clause at the time of claim settlement. Even if one knows it beforehand, at times it is not easy to decide the category of the room one will choose if a family member is carried in an emergency situation to the hospital. When you are already stressed being forced to go for a lower category room or facing a reduction on your claim amount can be a very challenging experience. It is, therefore, important to know what happens when claiming from a health insurance policy with room rent limits?
What is a sub-limit?
If your policy has sub-limits, then your insurer will pay only up to the specified limit of sum insured for certain expenses such as room rent and ambulance. It is usually 1 % of your sum assured. For example. If your cover is Rs 5 lakh then the insurance company will reimburse you only for Rs 5000 for room rent. Any expense above Rs 5000 has to be met out of your pocket. Besides room rent insurers also put sub-limits on pre-planned treatments such as cataract surgery, dental treatment, hernia, among others.
How room rent sub-limits work?
Depending on the room type -General, Shared, Private, Deluxe – hospital charge you different amount for the same service. Therefore, hospitals proportionately deduct all other hospital charges that are linked to the room you have chosen. For example, if your room eligibility is Rs 5000 but you opt for a room that has a rent of Rs 8,000 then other charges linked to the room such as doctor fees anaesthesia, surgery cost would also be proportionately reduced when the claim is paid.
What to do?
It is advisable to go for policies that do not have sub-limits. But if you opt for one, due to the lower premium, make sure how it works so that that you don’t run into trouble at the time of claim settlement. Moreover, you should know that by increasing the sum insured of the existing policy you can also increase the sub-limits. For example, if the room rent sub-limit is at 1% of the sum insured, then by increasing the cover you can also increase the sub-limit amount.