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Category: Health Insurance

Proportionate Deduction

A clause in health insurance policies, where if there is a capping on per day room rent in the policy and you avail a room higher than the eligible room all the other hospital expenses like consultation charges, surgeon charges, operation charges, etc. will get reduced as a proportion based on the difference between the eligible and the availed room charge. Only the cost of medicines and consumables which are sold as MRP are paid as per actual.

For example, if your room rent limit is 3000 and you opt for a room rent of 4000, then if your overall claim is 1,00,000, the insurance company will pay only 75,000 considering the ratio in with the room rent limit was exceeded. This is called the proportionate deduction under the terms and conditions of the policy.