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Room Rent Capping in Health Insurance Policy

Capping or sub-limit in health insurance is the restriction to the extent of benefits provided under a health insurance policy and room rent capping is one of the most common sub-limits. Room rent capping imposes a limit on the coverage of expenses related to hospital room during the stay required due to treatment.

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The feature of room rent capping usually gets overlooked when buying a health insurance plan but should be considered in order to make an informed decision.

What is Room Rent And How it Impacts Health Insurance Claims?

In case of healthcare treatment, typically, the patient is required to get admitted to the hospital at least one day before the surgery to undergo diagnostic tests and for general preparation. Also, hospitalisation is needed for a few days after the surgery as well for the purpose of observation. After discharge, the final medical bill reflects the room rent on a per-day basis.

In health insurance, coverage for room rent is restricted to a certain limit as per the terms and conditions specified by the health insurance company irrespective of the sum insured under the health insurance policy. This monetary limit is known as room rent capping. It is the limit imposed on room rent, nursing, and boarding expenses in the hospital. It can either be determined as the exact amount or as a percentage of the sum insured amount. For example, if the room rent capping is Rs. 3,000 under a health insurance policy with sum insured of Rs. 5 lakh, then the policy will cover all the boarding expenses up to Rs. 3,000. But if the limit is determined as 2% of the sum insured, then the room rent limit will be Rs. 10,000. Note that the claim settlement for hospitalisation in health insurance totally depends on the basis of room rent capping under the plan. Apart from room rent, other treatments and doctor’s fees also depend on the room rent limit.

Types of Room Rent Cover Under Health Insurance Plans

There are different types of room rent cover under health insurance plans. These are explained below:

1. Room Rent Without Capping

Room rent without capping is one of the most popular and demanded features in health insurance plans wherein the insurance company puts no restriction or limit on the room rent. The policyholders can choose from the room type as per their requirement, be it a general ward, or a private room.

2. Room Rent With Specific Room Types

Some health insurance plans come with restrictions on the type of room. The insured can opt for a suite, a twin-sharing suite, or a private room. This feature allows the patients to get admitted only to the pre-specified rooms.

3. Room Rents Co-Payment

Co-payment in health insurance is the percentage of the claim amount that the insured has to bear under a health insurance plan. The co-payment basis allows the insured to share the room rent expenses with the insurance company. When a health insurance policy has a specific room rent limit, then anything above the specified limit is to be borne by the insurance company. Co-payment is a less preferred feature as it requires the insured to pay out of their own pocket as well.

4. Room Rents Without Sub-Limits As Add-On Cover

Add-on covers in health insurance are additional features that can be purchased with a base health insurance policy by paying an extra premium.

Some health insurance plans come with an add-on cover of no room rent capping that the policyholders can opt for as per their requirements. Note that it is not a default feature and does not come with every health insurance policy.

What is The Solution to Room Rent Capping?

There can be two cases related to your health insurance policy. First, when you are already covered under a policy with room rent capping, and secondly when you are looking for a new health insurance policy. Read below to know the solution for room rent capping in both cases.

    1. Already covered under a health insurance policy with room rent capping: In this case, you can plan to change your health insurance policy or health insurance company to the one that comes without any limit on room rent. The process is known as health insurance portability and is allowed by all the insurance companies offering health insurance plans. It increases the limit on room rent capping and offers you the flexibility to select a room of your choice without affecting much the claim amount.
  • Looking for a new health insurance policy: In case you are going for a new health insurance policy, then it is recommended to thoroughly read the policy brochures to find out if there is any room rent clause in the policy. In case you still do not find the clause anywhere, then to be doubly sure, you may get in touch with the customer care executive of the insurance company and ask your doubts. This will help you make an informed decision.

Why No Room Rent Capping is a Preferred Choice?

There are several benefits of choosing a health insurance policy without any room rent, which makes it a preferred choice amongst many. Some of them are explained below:

  • Hospital room as per your choice: The primary benefit of choosing a health insurance policy without a room rent limit is that it allows you to avail of treatment in a room of your choice. Choosing a hospital room of your choice makes your experience at the hospital much better. It is all up to you whether you want to share a room or want a private room.
  • Freedom to benefit from health insurance according to your choice: Another benefit of buying health insurance plans without any room rent is that you get the flexibility to avail yourself of coverage from health insurance as per your own choice. As the insurance company offers you financial protection for the total expenses arising due to treatment, therefore you can divide the expenses as per your choice and requirement. For instance, you can choose to upgrade your room or may want to use the sum insured amount for the treatment, as you want to divide the sum insured. But be informed that the expenses will be covered only up to the sum insured limit.
  • Comfortable stay at the hospital: Your sickness may increase if you do not find comfort in the hospital that you are staying. Hence, it is recommended to choose a hospital room that offers you the utmost comfort during tough times, which is possible if you choose a health insurance policy without room rent capping. It helps you decide whichever hospital room so that you can avail the required treatment without any further stress.

To avoid paying inflated charges of medicines, etc. when staying in the premium or deluxe hospital rooms, it is recommended to buy a health insurance policy with no room rent capping. One can also go for a health insurance plan that has a higher room rent capping limit so that it can cover any room the policyholder wishes to take. This will ensure total peace of mind during the stay at the hospital. So, if thinking of buying a health insurance policy online, one must go through all the terms and conditions, and limits and coverage features under the policy before getting one.

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FAQ About Room Rent Capping in Health Insurance Policy

  • What is room rent capping in health insurance?

    Health insurance companies cover room rent up to a specific limit under the health insurance plans offered by them. This monetary limit is known as room rent capping in health insurance. Generally, there is a room rent capping of 1-2% of the sum insured in most health insurance plans. 

  • What are sub-limits in health insurance?

    A sub-limit is an extra limit in the coverage for losses under a health insurance policy. These losses can be a part of the sum insured limit. Your insurance company can limit the coverage by including sub-limit in the terms and conditions of the policy. 

  • What is the impact of room rent limits when selecting a health insurance policy?

    When selecting a health insurance policy, people search for a policy which comes without any limit on the room rent. You are free to opt for a policy with a room type of your choice, be it a private room or a general ward. Also, some insurance companies cover specific types of rooms. Amongst them, you can choose a suite, a private room, or a twin sharing room. 

  • How is room rent capping impact health insurance claims?

    Your health insurance claim for in-patient hospitalisation expenses incurred during the treatment entirely depends on the room rent limit under your policy. Not only for room rent, but there will be a restriction on doctor’s fees and other treatment costs. 

  • What is an example of room rent capping in health insurance?

    For better understanding, here is an example of room rent capping. Let us say if the sum insured amount of your health insurance policy is Rs. 3 lakh and there is a capping of 1% per day, then the insurance company will pay only Rs. 3,000 per day towards the room rent. 

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