Know the Concept of Sub-Limits in a Health Insurance


Purchasing health insurance may not be tough but choosing an ideal insurance policy is not as easy as it seems. There are many features such as, deductibles, waiting period, and ambulance cover based on which you can analyze various health insurance policies. One of the significant deciding factors is the sub-limits in health insurance. A sub-limit is an additional limit in medical insurance in the form of a limit on the claim amount for a particular disease or treatment procedure.

Understanding Sub-Limits

A sub-limit is applicable on room rent, ambulance cover, and some medical procedures. It is an important feature that helps in assessing a health insurance policy. They are denoted as a fixed value for an ailment or treatment but it can also be considered as a percentage of the total sum insured. In most cases, there are two types of sub-limits on the insured-on the hospital room rent and sum assured for certain diseases. There is always an option to consider or not to consider sub-limits. An insurance policy with no sub-limits comes with a higher premium. Make sure to check if charges such as room rent and medical expenses are within the reimbursable expenses before taking a treatment. The main purpose of placing sub-limits in the policies is to lower their overall claims outgo or control the liability to pay. The cost is calculated and estimations are based on current rates charged by hospitals to reduce the risk of fraud and unfair medical bills by customers. For your understanding, let us discuss the two major sub-limits to make buying insurance policy simpler for you.

Sub-Limit Cap On Hospital Room Rent

In the sub-limit option for room rent, the room rent is paid every day but only up to some limit. If you go for a treatment and there is the option of the general room or semi-private room in the insurance policy and if you are looking for a private room then you may need to pay the extra amount from your expenses. Let us supposed your room rent cap is Rs. 3000 and you take a room that costs you around Rs 4500, then you will pay the difference of Rs 1500 from your pocket.

Sub-Limit Cap On Certain Treatment

If you have decided to opt for an insurance policy with sub-limit on a certain treatment, you should check the list of ailments that are included in the sub-limit and the cost that is specified against each expense. If the sum assured is high, but you will not claim for the whole treatment because of the sub-limit on certain medical procedures. Let us suppose there is a sub-limit clause of 50% of sum assured for the treatment of cancer. Then, the sum total assured is Rs 15 lakhs, you cannot claim more than Rs 7.5 lakhs because of the sub-limit clause.

What To Do If Sub-Limits Are Mandatory?

Before buying an insurance policy you must check whether the sub-limits are applicable. Hence, it is advisable to read all the policy documents and check the inclusions and exclusions of the insurance policy. If you feel that the actual coverage offered in a policy falls short of your requirements or healthcare costs, you can increase your sum assured, or else you might need to compromise on your finance. Be sure to go through the sub-limits and then gauge the merits and demerits before buying an insurance policy.

Final Word

A health insurance cover with no sub-limits comes with a higher premium when compare to a policy with sub-limits. Therefore, it is advised to opt for a health insurance policy with sub-limits. You can buy a health cover from Care Health Insurance (Formerly known as Religare Health Insurance) that offers wide coverage. Before opting for a health insurance policy, be sure to assess your needs and understand its features. This is when the sub-limits feature is really helpful.This allows you to get quality treatment with the help of a health insurance policy. Also, you may get lower premiums by opting for sub-limits.