What happens when you exceed the room rent limit of your health insurance?

If the room rent limit is not sufficient in your health insurance policy, it will cost you more on claims in the form of proportionate deduction..

Room rent limit is a very important factor while choosing your health insurance policy. A lot about this factor has been written widely by a lot of people. So, we are writing down the gist of important things a customer should consider about room rent limit while purchasing a health insurance policy.

Room Rent usually includes the rent, nursing charges and the fees related to the Resident Medical Officer (RMO).

Room Rent limits are imposed in three different ways,

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Room Rent Limit – Why and how it is important

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance.

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance. The limit is expressed as an absolute amount or as a percentage of Sum Insured or by the category of room. For instance,

  • If the allowed room rent limit in your health plan is ₹5,000, your plan would cover your boarding expenses up to ₹5,000.
  • If the limit is expressed as 2% of the Sum Insured and the chosen Sum Insured is ₹5 Lakhs, your plan would cover your boarding expenses up to ₹10,000.
  • If the limit is expressed by the category of room as Single Private room, then your highest eligible category is Single Private Room.
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Proportionate Deduction

Be sure you don’t overboard your room rent limit to avoid proportionate deductions in claim.

Many health insurance policies have a certain capping on per day room rent either limited to a category or as a percentage of Sum Insured. When you avail a room, higher than the eligible category or limit, a proportionate deduction is applied to the overall treatment expenses ie., the overall claim amount will be reduced as a proportion of difference between the eligible and the availed room cost. Only the cost of medicines which are sold at MRP are paid in actuals.

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