Advertising
Having bought a health insurance policy of a certain sum assured—let us say Rs. 2 lakh—you would expect the policy would cover hospitalization expenses up to that amount. But in case your policy has one or sub-limit clauses, you should be prepared for the possibility of receiving considerably less by way of coverage.
A sub-limit on a health insurance plan represents a cap on the coverage available for certain kinds of medical expenses. The most common types of sub-limits are those that cap coverage on hospital room rents and on already specified diseases. But even apart from these two areas, sub-limits may apply on a variety of miscellanies including operation theatre charges, doctor’s fees, ambulance charges, diagnostic tests, medicines and so on.
In order to understand the extent to which sub-limits can affect your health insurance coverage, it is important to understand how they work. Let us focus on three kinds of sub-limits in the following:
- Sub-limits on hospital room rent – The cap on room rent usually takes the form of percentage of the sum assured. A one percent sub-limit is common. This means that on your policy of Rs. 2 lakh, your insurer will provide room rent coverage of up to Rs. 2,000 per day. This also means that if you choose to stay in a costlier room, any expenses incurred above Rs. 2,000 will have to be paid by you. One problem with this kind of a sub-limit is that, unless you are willing to pay out of your own pocket, it reduces your access to better hospitals because these may charge higher tariffs for rooms. Another issue is that hospitals frequently charge more for treatment if you are admitted in a more expensive room. At this point, it is important to determine whether your insurer will also pay in line with the costs expected for a cheaper room, and leave you to pay for the excess.
- Sub-limit on sum assured for specific diseases – Another common sub-limit involves a cap on the coverage for certain diseases. These diseases as well as the available coverage will already be mentioned in your policy. Imagine that there is a sub-limit of Rs. 50,000 (25 percent of the sum assured) for something as common as kidney stones. This means that although you have an overall sum assured of Rs. 2 lakh, when it comes to kidney stone removal, your insurer will pay a maximum of Rs. 50,000 towards treatment costs. If your medical expenses exceed that amount, the excess costs will have to be borne by you.
- Sub-limits on pre- and post-hospitalization expenses – Although pre- and post-hospitalization care are crucial for recovery and expensive, health insurers are not always willing to provide full coverage for medical expenses incurred before and after hospitalization. There could be a cash ceiling or a ceiling on the percentage of the sum assured payable. In either case, paying any additional expenses would be your headache, even though you have far from exhausted your total sum assured.
As you can see, sub-limits are a bad idea. It is best to avoid such health plans entirely. But if you cannot do that, make sure to read the policy bond carefully to ensure that the sub-limits do not eat into your health coverage.
That it "What are sub-limits in a health insurance plan?", Hopefully it can give information For you. Thanks YourInsuranceStep Update.