The terms and conditions related to health insurance policies often become a cause of trouble for the customers at the time of claim. Because of this, buying a health policy seems a bit difficult task. However, the insurance regulator IRDA is constantly working on these problems of the customers, trying to make the terms and conditions of health insurance more easy. Everyone knows about the concept of room rent sub-limit in health insurance. Actually, under this facility, a limit is set for the room expenses during hospitalization.
However, most people are confused about the room rent limit. Customers think that we have the protection of health insurance, so the insurance company will pay for all the expenses incurred in the hospitals. Since this is true but some conditions are also stipulated in it. Room rent sub limit is one of them.
It is important to understand the room rent sub limit rule.
Suppose you have a health insurance plan of Rs 3 lakh, in which the room rent sub limit is 1% of the sum insured. That is, you can take a room of 3 thousand rupees per day in the hospital. Because this amount is available for the room rent sub limit in the policy.
If you stayed in the hospital for five days as cheap rooms were not available in the hospital you chose a room which cost Rs 5,000 per day. (Remember that your policy limits this to Rs 3,000 per day) Now suppose, your total bill for five days hospital stay comes to Rs 2 lakh.
The effect of room rent sub limit on the entire bill You will feel that since your sum insured is Rs 3 lakh and the bill (Rs 2 lakh) is much less than that, your claim is largely settled except for a few thousand rupees of the additional room rent But it is not true. Because the condition related to the room rent sub limit proves your calculation wrong. This not only affects the rent claim of the room but also affects the entire bill. Learn how….
According to media report, your claim will be settled only in proportion to the ceiling of the room rent. Rs 2 lakh * (3,000/5,000) = Only Rs 1.2 lakh will be paid by the insurance company and the remaining Rs 80,000 will be borne by you.
What to do to avoid this inconvenience?
It is not that if you have health insurance of 3 lakhs then all bills will be settled within that limit. Room rent ceiling plays the biggest role in deciding the actual amount to be paid by the insurer in settlement of your hospital bills.
The best way to avoid this situation is to take a health insurance plan that does not have any limit on hospital room rent. These days many such schemes are giving this facility.
If you already have a health insurance plan, check the room rent sub-limit. If you feel it is not suitable for you, ask your insurer to remove the room rent limit by paying additional premium (loading).
