Every individual looking to get a health insurance policy should consider a set of factors before making a decision. They include the coverage amount, waiting period, cashless feature, co-payment, and exclusions. Sub-limit is also a vital aspect of any health policy, and every policyholder should be aware of how it can impact their health insurance claim. Let us understand the feature of room rent limit in health insurance and why you should consider it when finding a health cover for you and your family.
Room Rent Limit in Health Insurance: How They Work?
Room rent limit refers to the limit up to which the insured's per day hospital room charges will be covered in a health insurance policy. Let us suppose the room rent limit is Rs 3,000 per day. If a policyholder chooses a hospital room that costs Rs 2,500 per day, the expenses will be covered under the health policy. However, if the room costs Rs 3,500 per day, the person must bear the amount exceeding the limit from his pocket.
Generally, the sub-limit on ICU charges and room rent limit in health insurance is 2% and 1% per day, respectively. For example, if a person opts for a health policy of sum insured Rs 5 lakh, the room rent expenses incurred by the policyholder will be covered up to Rs 5,000 per day of hospitalization. Hence, the insurer will not cover the particular expenses above the specified limit, irrespective of the total coverage amount of the policy.
Significance of Sub Limit on Room Rent in Health Insurance Plans
Health insurers include the sub-limit clause with the objective to minimise their liability to pay to the policyholders. A health policy that has no sub-limit is considered advantageous for an individual. Sub limit in health insurance can be included in a policy as a percentage of the total sum insured or specified as a fixed amount for specific treatments or medical expenses.
Hospitals usually have different room categories and provide varied packages based on the room rent type one chooses. If the room rent category specified in the policy is general room and the insured opts for a private room, they have to bear the amount that exceeds this limit.
One should also be aware that the hospitalization charges, like doctor’s visit, surgery costs, nursing expenses, etc., are linked directly to the room category. That means if one has opted for a deluxe room, other medical expenses will accordingly increase. Hence, it is better to opt for a room for which the rent is within the specified sub-limit in a health policy.
Final Word
If there is a sub-limit in a health insurance policy, you must understand that it would reduce your claim amount. So, it is always better to review different health policies, which would help you make the right choice. Check the room rent sub-limit, among other features included in it. Similarly, health policies include sub-limits for specific medical treatments like cataract surgery and total knee replacement. If the policy has a cap of Rs 30,000 on cataract treatment, it implies the expenses incurred for the treatment will be covered only up to this limit.
Many health policies do not have any sub-limit like room rent limit. So, opting for such policies is advisable. It will save you from partial claim settlement, which can otherwise make you bear huge expenses. Get adequate information by reading the policy documents and choose a policy that helps you get the best coverage. This way, you will avoid any confusion when filing health insurance claims.
>>Check: Health Insurance Claim Process
Disclaimer: The information given in this article is only for reference purposes. Underwriting of claims is subject to policy terms and conditions.
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