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How Room Rent Sub-limit can affect your Health Insurance claim?

How does it affect your insurance claim?

Since the charges are linked to the type of room or the room rent, your medical bill for the same treatment goes higher if you choose better accommodation.

If your health coverage is without sub-limits, there is not much insurer can do. It will have to pay for all he covered expenses.

However, if your insurance plan has sub-limits, be prepared for a surprise. In this case, if the room rent per day exceeds the prescribed sub-limits (cap), the insurance will pay charges only in the proportion of rent sub-limit to actual rent.

Suppose room rent cap (or sub-limit) in your health plan is Rs 3,000 per day and the actual room rent is Rs 7,000. You get hospitalized for 4 days and run up a bill of Rs 1 lac. You might feel that insurance company will pay everything apart from excess room rent i.e. Rs 1 lacs – 4, 000 * 4 days = Rs 84,000. Well, that’s not the case.

The reimbursed amount will only be Rs 1 lacs * 3000/7000 = Rs 42,857. Even though you had total cover of Rs 5 lacs, it does not matter since the reimbursed amount will be in proportion of sub-limit and actual room rent. This will certainly come as a shock to someone who is not aware.

Avoid purchasing plans that have a cap on room rent.

If you already have a plan with room rent sub-limit, you can port to a new plan without sub-limits while retaining continuity benefits (waiting period).

Call for Portability or New plan
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