What Is Sub-Limit in Health Insurance?
Updated On Dec 04, 2020
Sub-limit is one of the vital features that need to be evaluated while purchasing health insurance online. It is explained as a fixed value, i.e. as a percentage of the total SI (Sum Insured) that a health insurance company pays for claims arising from associated medical expenses.
Sub-limit in health insurance can be of two types-one on room rent in the hospital and the other on the SI on the specific disease. Expenses like the medicine cost or expenses for surgery are capped with an amount specified under the sub-limit. To understand better, health insurance plans with no sub-limits have a higher premium, making it a preferable choice.
Sub-limit for specific ailments
Before coming to a conclusion on which health insurance to buy, it is crucial to check the enlisted diseases or ailments that are under the sub-limit clause and what is the cost specified for each one of them. This sub-limit is usually for more common ailments such as gallstones, kidney stones, piles, sinus, cataracts etc. There is a cap on the amount you can claim, in this sub-limit. It depends on your disease/treatment. The rest of the amount, the patient has to bear. Therefore, a high insurance cover does not always assure complete coverage.
Let us say there is a sub-limit clause of 50% of SI for cancer treatment. Here, even if your total sum assured is Rs. 10 Lakh, still you cannot claim more than Rs. 5 Lakh for that treatment due to the sub-limit clause.
So, to make hospitalization and claim settlement process hassle-free, always make sure to read and understand the sub-limit clauses thoroughly. Also, choose the health insurance that does not include certain discomfiting clauses, yet meeting your requirements.
Room rent sub-limit in health insurance
A room-rent sub-limit lets your insurance company cover the room rent per day to a certain limit. But there is capping in the type of room here. For example, if the policy specifies only the general room or semi-private room, but if you need a private room, then you will have to bear the remaining amount from your pocket.
Generally, room rent is limited to a maximum of 1.5% of the sum assured every day. Nowadays, hospitals offer different packages depending on the type of room rent you choose.
After being discharged, the insured individual will incur some post-hospitalization expenses. The insurer can put a sub-limit on the amount the insured will be able to claim for, in such circumstances.
As a smart policyholder, you must go for health insurance plans without sub-limits. It may demand a little more premium amount, but offers fewer hassles. So, at the time of medical emergency, the policyholder will not have to do the calculating task or keep track of spending according to the sub-limits specified in the policy.
To get enough information on what is right or wrong for you and decide accordingly on which plan to go for, contact the best health insurance brokers in the market, of which InsuranceDekho is one. You may drop a mail at firstname.lastname@example.org or visit the official website and leave your personal details there. Our team of experts will get back to you over call in no time and solve all your queries related to health insurance. AND, all the assistance is free of cost!