Sub-limit The Most Important Feature In Health Insurance Plans
The purpose of shopping for a insurance policy is to make sure that hospital bills don't pinch one's pocket. By paying a fraction of the coverage amount (sum insured) as premium.
The liability is on the insurance firm to reimburse the hospitalization cost to the health care provider. The reimbursement is up to the quantity of sum insured that's available within the policy. But wait! sometimes , the insurer might not reimburse the whole bill amount to the hospital.
The balance, in such a case, will need to be paid by the policyholder as out-of-pocket expense. This makes one wonder, why in spite of paying the premium on time, the insurers don't pay the whole hospital bill? this might be due to something called 'Sub-limit' during a insurance policy. While watching the features during a insurance policy, most folks often overlook this.
What is sub-limit?
Sub-limit refers to the upper limit up to which the insurance firm can pay for the hospital bill under various expense heads. Typically, a hospitalization will incur expenses under different heads like doctor's fees, procedure charges, nursing cost, medication cost and room rent. a number of these may have an upper cap, i.e. the utmost amount that the insurer will reimburse regardless of the particular bill amount.
Importance of sub-limit of room-rent Keep an eye fixed on them but more importantly, check out the sub-limit of the space rent. this is often because all other expense heads are linked to room-rent sub-limit. This makes the room-rent sub-limit a particularly important thing to observe out for and also adhere to. If you're hospitalized and therefore the hospital asks you to settle on the sort of room, it's important to stay to the space rent limit. Here's why.
Generally, the room-rent is capped at 1 per cent of the sum insured of the policy. So, if you've got a sum insured of Rs 6 lakh, the space rent sub limit will stand at Rs 6,000. Now, if you decide for an area with rent above Rs 6,000 a day, your hospital bill might not be fully reimbursed by the insured.
On choosing an area with the rent exceeding the limit, all other medical expenses as per the hospital bill get proportionately reduced. The reduction within the hospital bill happens within the same proportion because the room rent exceeds the mandated limit. for instance , if the room-rent limit exceeds 33 per cent by choosing an area costing Rs 4000 rather than Rs 3,000 per day rent, all other expenses get reduced by 33 per cent. This leads to the partial payment of the claim and therefore the policyholder will need to pay the balance to the hospital.
What to do
In most hospitals there are rooms from private, semi-private to even executive suites that one can choose between . to form sure you do not need to pick some of the hospital bill and to make sure the insurer pays the whole bill amount to the hospital, it’s better to choose an area with rent within the permissible sub limit. Further, there are some insurance plans during which there's no sub-limit on any of the medical expenses, including room rent, but they'll come at a better premium. Few other plans allow one to get rid of sub-limits on paying alittle additional premium. Making an informed decision helps keep the concerns away during hospitalization.
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