Know the sub-limits in the health insurance policy

The Covid-19 has made people realize that health emergencies can strike without warning. Additionally, with medical costs skyrocketing, having adequate health insurance has become a necessity. Among the various factors that you need to watch out for when choosing health insurance, there are the sub-limits.

What are they

The health insurance sub-limit refers to a monetary cap by an insurer on expenses related to the treatment of illnesses, room rent and post-hospitalization and expenses related to planned medical procedures. This means that the insurance company will only cover expenses up to a predetermined limit. Anything beyond that must be borne by the policyholder.

The sub-limit, however, varies according to the claims. It can be a certain percentage of the sum insured, or up to a certain specific amount. For example, intensive care costs and rent limits for hospital rooms are generally 2% and 1%, respectively, of the total sum insured. Additionally, many health insurers allow you to opt out of sub-limits for an additional premium. You can choose between the two options depending on your budget.

Types of sub-limits

Disease specific: Most insurers have sub-limits on pre-planned medical treatments, in the form of a set cost for procedures such as cataract removal, knee ligament reconstruction, kidney stone removal. , tonsils and sinus removal. The list of conditions and the ceiling for treatment costs differ from one insurer to another. The care sub-limit is not tied to the sum insured, which means that even if an insured has a high sum insured, the sub-limit clause in the policy will prevent them from claiming their full costs. of care. For example, if your policy has a 50% sub-limit clause on a certain medical procedure and your total sum insured is 5 lakh, you will not be able to claim more than ₹ 2.5 lakh for that treatment due to the sub-limit clause. .

Room renting: This is the maximum rent or room category you are entitled to based on your health insurance coverage. This is usually 1% of your total insured. For example, under a 10 lakh policy with a 1% sub-limit on room rent, the insurer will approve a hospital room with a maximum rent of 10,000 per day. If the rent for the room exceeds the fixed sub-limit, the policyholder will have to bear the rest of the cost.

There will be a cap on associated services such as physician consultation fees, anesthesiologist fees, diagnostic tests as well, as various hospital fees are linked to the type of room that is chosen and the applicable sub-ceiling. on the rent of the rooms.

Post-hospitalization: In many circumstances, insureds will be required to remain at home under medical supervision for a period of time after treatment. Many insurers cover post-hospital costs with sub-limits, requiring policyholders to pay part of the cost.

Compared to a policy with sub-limits, health insurance policies without sub-limits will have a higher premium. If you have sub-limit coverage, make sure your medical expenses don’t exceed the threshold. So before buying a new health insurance policy or renewing an existing one, make sure you get one that adequately covers you.

The author is Head-Health Insurance,

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