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What Is Capping In Health Insurance?

Published On May 04, 2022

Any of us can experience medical complications, and in order to protect against it in the best way you can, you should have health insurance that offers appropriate coverage. While a health insurance policy is one of the most essential investments you will ever make, it is necessary to read the fine print on it carefully in order to ensure that your claims are not rejected later.

What Is Capping In Health Insurance?

What is Room Rent Capping?

One of the most important considerations within your health insurance policy will be regarding the room rent capping, which will dictate the limit of your hospital room costs that will be borne by the insurer. It could either be a whole figure stating that only this much of room rent expenses will be paid by the insurer, or as a percentage of the sum assured.

Your health insurance policy will usually explicitly state the room rent capping. For instance, if your room rent capping is set at Rs. 5000 by the insurance policy, your hospitalisation expenses of only upto Rs. 5000 can be claimed from the insurer.

How does Room Rent Capping Affect Health Insurance Claims?

If you raise claims with your insurer for any treatment you have undergone, a large part of the settlement made will be dependent on the room rent limit. If you go overboard in terms of the amount paid as room rent, the other expenses borne by your insurer can be reduced.

Here’s an example. If you buy a health insurance policy with a sum assured of Rs. 5 lakh, and your room rent limit is set at 1% of the sum assured. This means your room rent is capped at Rs. 5000. Now the other expenses you incur such as a surgeon’s fee, the cost of surgery itself, medicines, medical tests can also be affected owing to this cap. You can be compensated for all of these other expenses only if your room rent is below Rs. 5000. However, if it is above that amount, your claim would get reduced in the same proportion at which the room rent limit has been exceeded.

Importance of Room Rent Capping while Selecting Policy

Now you know how significantly your room rent capping impacts your health insurance policy, it is important that you consider this factor while selecting the best health insurance policy for you and your family. Ideally, you should go through several health insurance policies and understand each of their terms and conditions. Identify the policies which are lenient in room rent capping and then take your decision in an informed manner.

Tips to Keep in Mind Related to Room Rent Capping When Choosing Health Plan

Every policy has to be carefully selected by the person buying it, ahead of its purchase. Regardless of what you are looking for, it is necessary for you to understand the different terms and conditions associated with the policy. Before you buy your policy, you need to carefully go through the terms and conditions that are associated with it to ensure that you do not end up losing more money in case any medical emergency crops up.

Along with reading the fine print of each policy document, it is best to study a couple of policies to understand the different terms and conditions associated with each policy to gain an understanding.


Different policies have different pros and cons to them. Hence, you are requested to read the policy terms and conditions before you purchase any policy. 

Also Read: top child-protection ideas in the face of the COVID-19 pandemic


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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