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,

Continue reading “What happens when you exceed the room rent limit of your health insurance?”

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.

Suppose you choose a room rent that exceeds the limit, then all the other charges related to the treatment will be settled by the Insurance company on the same proportion. 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.

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.

Continue reading “Proportionate Deduction”