What are Sub Limits in Health Insurance ?

Having taken the decision to take health insurance to protect yourself and your families from expenses that might arise from any untoward health emergency is only half job well done. Buying a health insurance that suits your needs and is able to meet the objectives is of paramount importance. Health insurance plans have features which include day care procedures, co-payment clause, cashless cover and waiting period and exclusions that one needs to take care of before zoning on a final health plan.

Sub-Limits in Health Insurance plans means the limits that are imposed by the health insurance provider on the payment of sum assured when a claim is raised by the policyholder due to treatment of any medical condition. It is a monetary limit place by the insurance provider on medical insurance claim. These limits are placed on hospital room rent, ambulance charges, nursing and doctor’s charges, cataract removal, knee replacement charges etc.

Why Understanding Sub-Limit in Health Insurance Policy is Important:

Identifying and Understanding the Sub-Limits in Health Insurance is a critical aspect in choosing the health insurance plan. Incomplete awareness and understanding of this aspect can lead to a major shock or you may be unprepared to meet the costs of treatment. Sub-Limits are usually mentioned as a fixed value for treatment of any particular disease/illness or can also be expressed as a percentage of Sum Assured for specific diseases. Health Insurance plans that have less/ no Sub-Limits have high premiums.

We will discuss two important Sub-Limits so that You Can Choose appropriate Health Insurance Plan:

  1. Sub-Limit on Room Rent:

The Room Rent Sub-Limit limits the liability of the health insurance provider to a certain amount or certain percentage of costs that are related to room expenses and also insurer can also place restriction on the type of room including general room or the semi-private room. If your room rent is Rs 8, 000 and the policy has sub-limit of Rs 4, 000 then the policyholder has to fork out Rs 4, 000 from his/her own pocket.

Most of the medical expenses that include doctors and nursing charges and surgical procedures or the operation theater charges also depend on the type of room the policyholder avails of therefore these expenses adds up to the cost and sub-limit further increases the difficulties of the policyholder. The policyholder needs to discuss the sub-limit clues with the insurance provider to be clear and to avoid any unwanted surprises at the time of claim settlement.

  1. Sub Limit on Specific Treatment:

Before you finalize on the health policy based keeping in mind sub-limit you need to checklist of diseases/ conditions which are listed in the sub-limit clause and also the limit on the costs that are associated with them. It is not possible to claim the entire cost for treatment/hospitalization if there are sub-limit clause even though the sum assured that has taken is high. If the sub-limit for the cancer treatment is Rs 15, 00,000 and the sub-limit clause states that in case of cancer treatment the health insurer would make payment up to 50% of the cost then the insurer would pay only Rs 7, 50, 000, the rest will have to be paid the policyholder.

Therefore for an assured and hassle-free claim settlement, the applicant needs to have a thorough understanding of Sub-Limit clauses and choose only those policies that do not have discomfiting clauses and is able to meet the budget and needs.

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