How Room Lease Sub-limit can have an effect on your Well being Insurance coverage declare?


High quality healthcare is getting costly with every passing day. And it is very important purchase sufficient well being protection to have some cushion towards the rising well being care prices.

Nonetheless, shopping for medical health insurance is just not simple.

Why? As a result of the insured occasion is just not very goal.

Distinction this with life insurance coverage. There is only one insured occasion. The demise of the policyholder. And it’s an goal one too. If the policyholder has handed away, the insurance coverage firm should pay. There is no such thing as a confusion about whether or not the policyholder is useless or alive. And all of the plans cowl the identical insured occasion. You may simply go along with the most affordable life insurance coverage plan (do have a look at the declare settlements too).

In medical health insurance, there are tons of insured occasions. There may be at all times a component of subjectivity concerned. You may’t ensure whether or not a specific remedy is roofed until you test with the insurer.

There are a number of variants. Particular person, household floater, top-up and Tremendous top-up plans. Furthermore, totally different insurance policies supply totally different protection. For example, Coverage 1 covers process X and never Y. Coverage 2 covers process Y and never X.  There are ready durations, sub-limits, co-payment clauses, disease-wise capping, no-claim bonus, restore advantages and many extra. And plans will range on these parameters too. Not simply that, every firm has 5 totally different plans. Completely different protection and premiums.

This makes selecting a medical health insurance plan troublesome. You may’t simply go by the bottom premium. You need to perceive the protection and options of the plan to know whether or not that is proper match for you.

On this put up, we have a look at a crucial parameter that you need to take into account earlier than shopping for a medical health insurance plan. Room-rent sublimit. Should you get this improper, your insurer is not going to reimburse/cowl the total price of remedy even when the remedy is roofed below the plan.

What are Sub-limits?

Because the identify suggests, throughout the general Sum Insured, the insurance coverage firm covers a specific expense solely as much as a sure restrict. For example, regardless that the Sum Insured is Rs 5 lacs, the coverage might cowl remedy for a sure sickness solely to the extent of Rs 50,000. Should you incur Rs 65,000 on hospitalization for such sickness or process, you’ll have to pay Rs 15,000 from your personal pocket.

Sub-limits might be structured in any means. There is no such thing as a particular IRDA guideline on the matter. You need to learn the phrases and situations of the well being cowl plan to know if there are any sub-limits within the plan. With these sub-limits, the insurer can restrict its legal responsibility to a sure extent.

Due to this fact, medical health insurance plans with sub-limits are more likely to be cheaper than these with none sub-limits.

Probably the most essential sub-limits in a medical health insurance plan is the cap on room lease. With this cover, the insurance coverage firm caps its legal responsibility on room lease per day.

Peculiar nature of hospital fees

Hospital fees are linked to the kind of room you’ve got taken. Physician’s go to to a shared room will price you Rs 1,000. Nonetheless, if in case you have taken a non-public room, go to by the identical physician might be charged at say Rs 2,000 per go to. It is mindless however that’s the way in which it’s.

A easy X-ray that prices Rs 500 for a shared room might price Rs 1,000 if in case you have taken non-public room. It’s a must to go to the identical X-ray room and stand earlier than the identical machine however the fees are totally different.

In different phrases, the hospitals cost you on the premise of your means to pay.

And what higher indicator of your cost means than the room you’ve got chosen to remain in!

Out of your perspective, your protection will deplete quick if you’re staying in an costly room. And you may’t ignore that in case your remedy is extended.

How does this have an effect on your insurance coverage declare?

For the reason that fees are linked to the kind of room or the room lease, your medical invoice for a similar remedy goes increased when you select higher lodging.

In case your well being protection is with out sub-limits, there’s not a lot insurer can do. It should pay for all of the coated bills.

Nonetheless, in case your insurance coverage plan has sub-limits, be ready for a shock. On this case, if the room lease per day exceeds the prescribed sub-limits (cap), the insurance coverage can pay fees solely within the proportion of lease sub-limit to precise lease.

Suppose room lease cap (or sub-limit) in your well being plan is Rs 3,000 per day and the precise room lease is Rs 7,000. You get hospitalized for 4 days and run up a invoice of Rs 1 lac.  You may really feel that insurance coverage firm can pay every thing other than extra room lease i.e. Rs 1 lacs – 4, 000 * 4 days = Rs 84,000. Effectively, that’s not the case.

The reimbursed quantity will solely be Rs 1 lacs * 3000/7000 = Rs 42,857.  Though you had complete cowl of Rs 5 lacs, it doesn’t matter because the reimbursed quantity might be in proportion of sub-limit and precise room lease. This may actually come as a shock to somebody who is just not conscious.

Usually, that is accomplished for hospital providers. Medicines are reimbursed at MRP regardless of the room lease.


Please be aware that the fee for medicines to be reimbursed is similar because the precise price. It’s a must to pay Rs 1.12 lacs from your personal pocket.

Room rent sub-limit room rent cap

Please be aware that the fee for medicines to be reimbursed is identical because the precise price. It’s a must to pay Rs 1.12 lacs from your personal pocket.

What must you do?

Keep away from buying medical health insurance plans with room-rent sublimit, particularly if you’re residing in larger cities.

Medical insurance plans from public insurers (Nationwide, Oriental, United) are likely to have room-rent sublimit. Often each day room lease is capped at 1% of the Sum Insured. For ICU, it’s 2% of the Sum Assured.

If you have already got a plan with room lease sub-limit, you’ll be able to port to a brand new plan with out sub-limits whereas retaining continuity advantages (ready interval).

Nonetheless, not everybody can afford a medical health insurance plan with out sub-limits. In that case, you should purchase a plan with sub-limits. Earlier than finalizing the plan, attempt to get an thought of room rents within the hospitals within the neighborhood or these hospitals the place you wish to get handled. Subsequently, decide up a plan the place room lease cap is sufficient for taking a room of alternative at these hospitals.

Typically, your hand might even be compelled. Though you wish to go for a shared or a less expensive room, it is probably not out there. In that case, you’ll have to decide a non-public room or take remedy in one other hospital. In case of emergency, that’s not an possibility. You are taking no matter is accessible.

So, when you can afford, decide up a plan with out sub-limits. Should you can’t, remember and be ready.

Different posts on Well being Insurance coverage Plans

Tax Advantages for Buying a Well being Insurance coverage Plan

Use this good Well being Insurance coverage Technique to get increased cowl at a decrease premium

How declare is settled if in case you have two Well being Insurance coverage Insurance policies?

Particular person Well being Insurance coverage Plan Vs. Household Floater

What are High-up and Tremendous High-up Well being Insurance coverage Plans?

How Well being Insurance coverage Corporations can simply trick prospects?

Medical insurance plans you need to keep away from

High 10 Exclusions below your Well being Insurance coverage Plans

Must you buy Crucial Sickness Plans?

Must you buy a Well being Insurance coverage Plan with Maternity Advantages?

Must you buy a Well being Insurance coverage Plan with Restore/Refill Profit?

What’s a Hospital Money Insurance coverage Plan?

Featured Picture Credit score: Unsplash

The put up was first printed in November 2015 and has been up to date since.


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