Sub-Limit in Health Insurance Plan

A health insurance plan is an insurance policy, which provides you coverage for medical bills and expenses incurred on hospitalisation. You can either be reimbursed for the medical bills and expenses, or avail cashless treatment facilities. In case of cashless treatment at an insurer’s network hospitals, the insurance company directly settles the amount with the hospital. Experts advise availing a health insurance policy as soon as possible to enjoy extensive coverage along with affordable premium payments. You must, however, remember that a health insurance policy will also have a sub-limit, or a condition that the insurance company will provide coverage only up to a limited extent. Sub-limits are applicable as a percentage of either the total billed amount or sum insured. The remaining amount has to be paid by the policyholder. 

Now you can avail a health insurance plan, available on Finserv MARKETS, and get access to individual or family health insurance policies. This will help you to deal with an unforeseen medical emergency without worrying about the medical expenses. What’s more, you can calculate the amount of premium instantly, using the online health insurance calculator. 

Understanding sub-limit in health insurance: The Insurance Regulatory and Development Authority (IRDA) has not stipulated any rules for sub-limits in health insurance policies. So various insurance companies have different sets of rules specifying sub-limits.  Typically, insurance companies will have the clause of sub-limit either on certain charges, like payment of hospital’s room rent, or on treatment of certain medical conditions. 

Types of sub-limits in health insurance : You must read the policy document carefully to know about the sub-limits in your health insurance. In case your policy document doesn’t list any sub-limit, you can contact the insurance company for clarification. Here is a look at the three different types of sub-limits in health insurance policies:

Sub-limit on certain ailments or medical treatment : This sub-limit is applicable if you are suffering from a commonly found disease. This could be hypertension, kidney stones, hernia, sinus, cataract, piles, tonsil, gallstone and so on. This clause can also be applicable on pre-planned medical procedures, including plastic surgery. For instance, the insurance company can specify a sub-limit of paying 80% of the medical bill, or 1% of the sum insured for such treatment/ medical procedures. 

Sub-limit on hospital’s room rent and other charges : Insurance companies can also specify a sub-limit clause for hospital’s room rent and other charges, like ICU charges, doctor’s consultation fees, diagnostic test charges, oxygen supply charges, ambulance charges and so on. The percentage of such sub-limit is contingent upon the terms and condition of the health insurance policy. 

Sub-limit on post-hospitalisation expenses : If you have undergone a major surgery or complicated medical procedure, you might be required to continue treatment even after being discharged from the hospital. Insurance companies providing a policy, which covers post-hospitalisation charges, can specify a sub-limit on such expenses. 

The effect of sub-limit on your medical claim : As sub-limits can decrease your total claim amount, you must be aware of such clauses before purchasing a health insurance policy. Some insurance companies can allow you to opt out of sub-clauses by paying a higher premium amount. The key to take precaution against sub-clauses is to assess the policy carefully, and make sure that it fits your budget. 

Conclusion : Sub-limits in health insurance are clauses capping your claim amount. Such terms and conditions makes it imperative to purchase a health insurance policy from a trusted and reliable insurer. The health insurance policies, available on Finserv MARKETS, comes with a wide slew of advantages like no cap on hospital’s room rent, swift claim settlement within 60 minutes, high-value sum insured up to Rs 50 lakh, optional air ambulance cover, cashless treatment at more than 6,500 network hospitals and so on. For your ease and convenience, Finserv MARKETS also allows you to calculate the premium amount, within minutes, through the online health insurance calculator. With the help of this health insurance calculator, you can be well aware of your medical insurance premium liabilities, and pick an ideal plan as per your needs. 

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