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In order to ensure that your health insurance plan serves you right, it is important to be familiar with all of its features; so that you know how to utilize it aptly in the time of need. Waiting period, co-payment, deductibles and cashless cover are some of the things we usually pay attention to. Sub-limits is one of the critical elements that we need to be well-aware of.
Insurance companies set a fixed value for particular illnesses/surgeries/services in their mediclaim policies. This is the maximum amount that it will pay for claims, associated with the related medical expenses. Some of the key sub-limits in health insurance policies include:
Ø Room Rent Sub Limit: Your company covers the per day room rent of your hospital, but only up to a certain limit. Hence, if your room rent allowance limit is Rs 2000 and you go for a room that costs more, you will have to pay the difference from your own pocket.
Room charges are linked to the hospital you choose as well as the type of room you go for. Hence, if you are not comfortable with a sharing room, make sure that you choose a health insurance that has a sub-limit for a private room. Discuss this clause with your insurance company to avoid any last-minute confusion.
Ø Specific Treatment Sub Limit: Some diseases/treatments come under the sub limit clause. You will have to check your policy wording in order to learn the specifics, as defined by your company.
These sub limits usually apply to more common ailments, like—sinus, cataract, gallstones, kidney stones, etc. Hence, even though your sum-insured would be high, you might not be able to claim your entire expense due to the sub-limit factor.
Ø Post Hospitalization Sub Limit: Some insurance companies put a sub limit to post-hospitalization expenses. Here, the sum that you can claim in such circumstances is capped.
By putting a sub limit clause with their health insurance plans, insurance providers ensure that the customers use their policies fairly. Hence, preventing them from overspending on expensive or needless services, just because the company is paying for them.
If you are going for a plan that has a sub-limit clause, make sure that you know and understand the limits.
To avoid the above hassles, you can opt for health insurance plans without any sub limits. Royal Sundaram’s Life Line health insurance plan comes without any of the above mentioned sub limits.