Group Medical or health insurance policies provide comprehensive coverage. When choosing a health insurance policy, it is vital to go with a policy or insurer which offers maximum coverage. Having said that, the coverage in the policy is subject to certain terms and condition. One of the conditions is linked to room rent allowance in the health insurance policy. Room rent basically is the maximum amount of charges the policyholder can claim per day when he or she is admitted to a hospital for treatment.
Room rent is an important component of health insurance coverage and the entire claim depends on it. Not only the room rent limits the coverage but treatment cost and doctor’s fees would get affected in the case the limit is exceeded by the insured.
Sub limit is the limit to which an insurance company will pay for the claims of the policyholder that result from an associated medical expense. Thus, the expenses like the cost of surgery or medicines will be limited to the amount mentioned in the sub-limit. For example – health insurance policy has a sum insured of INR 2 lakhs but the doctor fees are capped to 2% of the coverage. In such a case the insurer will pay only INR 4000 per claim even if the doctor’s fees were INR 8,000. The rest of the doctor’s fees has to borne by the policyholder from his own pocket.
Although sub-limit is applied to different components like doctor’s fees, pre-hospitalization charges, medicine cost but the most vital sub-limit is that of the room rent. The room rent sub-limit is mostly limited to a maximum of 1.5% of the sum insured of the health insurance policy. For instance – if a group medical insurance policy offers 1% of a submit cap with a sum insured of INR 3 lakhs then the room rent charges can be claimed only up to INR 3,000 per day. In other words, if the room rent charges are more than INR 3,000 then the policyholder will have to pay the difference form is own pocket as the cap on room rent is limited to INR 3,000 per day.
Exceeding the sub-limit may have unfavorable implications on the insured’s medical claim. Surpassing the sub-limit may lead your insurance company to cut your sub-limit for other expenses too. Although a policy with sub-limit might come less expensive but it is recommended to buy a health insurance coverage that comes with no sub-limits. You may have to pay more premium than a sub-limit policy but at the time of claim you will be at peace of mind in case of a medical emergency.
It is always recommended to go through the Mediclaim policy terms and conditions to understand the limitations/exclusions of the policy before buying. If you are in doubt then always get the help of an insurance expert to know the implications and restriction of a policy.