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What is the Room Rent Limit in Health Insurance?

Published On Feb 12, 2021, Updated On Apr 28, 2021

Most of the health insurance policies render comprehensive coverage and cover all aspects of healthcare from doctor fees to surgery costs. There are provisions to cover hospital room rent in the health insurance as well, and there is a particular limit imposed on the coverage as well, known as the room rent limit.

The room rent limit is the maximum amount of per day room charges that one can claim if they are admitted to the hospital. If the beneficiary chooses a room that is higher than the cap limit, then the additional cost has to be borne by the insured. The health insurance claim settlement depends completely on the room limit of the plan. Apart from room rent, the doctors’ fees and the treatment fee will also depend on the limit of the room rent.

Types of Health Insurance Room Rent Coverage

All the health care treatment costs, such as doctor fees, medicine cost, cost of test and surgery seems to be linked with the room rent. The charges for medicines, tests, and surgery will be more for a hospital room with a higher rent. There are four types of room rent coverage in health insurance and they are as follows:

1. Room Rent Without Sub Limits:

Under such plans, there will not be any restrictions on the room rent and offers the much-required freedom to choose the desired room type. Insurers enjoy complete freedom in choosing the desired room type and can go for either a private suite or a general ward. No restriction will be levied on the room type, under this health insurance clause.

2. Rooms with Co-Payment:

Some health insurance plans will impose room rents on a co-payment basis. Under this clause, if the policy specified a room rent limit, and the insurer chooses a room with a higher cost, then the additional rent will have to be borne by the insured.

3. Rent Cover on Specific Room Types:

Some health insurance policies prescribe specific room types, such as a twin-sharing suite or a private suite. And the policyholder has to get hospitalized in these pre-mentioned room types only.

4. Room Rent Limits with Add-On Cover:

Policyholders can buy room rent sub-limits as an add on cover. Even if they don’t get it in their policy, they can pay an additional sum to get cover for suite rooms or private rooms.

Impact of the Room Rent Limit on the Health Care Claims

If the insurer opts for a room of higher charge, then the insurer will reduce the claim settlement amount partially. The insurer will reduce the entire claim on the bill on a pro-rata basis. For example, if the policyholder is eligible for a room rent of Rs. 2,000 but he opts for a room rent of cost Rs. 3000 or Rs. 4000, then the claim can be reduced to 50% or 30% of the total bill.

Bottom Line

Since hospitals impose their treatment charges based on the room selection, it is the responsibility of the policyholder to choose rooms as per their room rent cap limit. Policies with a higher sum assured do not impose limits on room rent. For those seeking a policy with a lower sum insured, it is important to learn how the sub-limits and co-payment clause affects the claim.

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.

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