Concept of Room Rent Limit in Health Insurance & Why You Should Stick to It?

Room rent is the room or bed fee per day that the hospital charges the patient to pay. With the health insurance , the policyholder's room rent expenses are settled by the insurer. The sub-limit on rent of the room is very relevant when claim is concerned. In most health insurance plans, the cap/sub-limit on reimbursing claims for other/related medical costs is related to the room-rent cap/sub-limit. As such, the policyholder is advised to comply at all times with the cap/sub-limit on room rent.

Types of Room Rent Coverage

There are 4 types of room rent cover in the health insurance policy.

1. Room Rent sans Sub-Limits: There is no limits/restrictions on the rent of the room. The policyholder can choose any type of room of his/her choice
2. Room Rent, Specified Room Types: The insured is allowed to be admitted to only pre-specified rooms. For instance, the policyholder can choose a suite, a private room, or twin-sharing suite.
3. Room Rent Co-Payments: When the insurance coverage has a specific cap on room rent, the insurer will pay for anything above the specified limit. This enables the insurer to share the room rental expenses
4. Room Rents san Sub-limits as ‘Add on Cover’: As an ‘add on the cover’ and by paying an additional premium, the insured gets room rent without sub-limit.

Effects of Exceeding Sub-Limit

The following are the “consequences” of not following the sub-limit/cap for room rent.

1. Not adhering to the cap/sub-limit on room rent cap does not have a positive impact on the overall claim that the insurer settles. If the policyholder exceeds the cap /sub-limit of the room-rent, the insured reduces the sub-limit payment proportionately for other related medical expenses.

2. The sub-limit for reimbursing related medical costs is reduced to the “extent” as the ‘room rent’ permitted limit is exceeded. Hence, if the policyholder exceeds the cap/sub-limit on the room-rent cap the reimbursement sub-limits for other related claims are decreased in equal proportion. This leads to partial health insurance claim settlement and the rest of the costs/expenses must be borne by the policyholder. This leads to customer dissatisfaction and grievance.

What to Do?

1.During hospitalisation, sort out the relation between the room-rent limit and other expenses. It is better to stick to a room with the rent under the allowed sub-limit if the other expenses and room rent sublimit are related.

2.Alternatively, select a policy/plan that ‘does not have” the sub-limit provision, even if the policy's premium amount is higher. The advantages of such policies are much greater. Many of the health insurance policies offer the possibility to no include the sub-limit provision by paying an additional premium.

Conclusion

Though brochures of most health insurance companies explicitly specify the different sub-limits, nevertheless the policy document often addresses the substantial 'proportionate reduction' of the claim quantity provision. It is better to adhere to the room-rent limit to prevent partial settlement of claims and for good customer service. Alternatively, go for a policy without sub-limits.

Also Read

Best Health Insurance Policies Without Room Rent Sub-Limit

Top 5 Health Insurance plans in India

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.