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Be Cautious, Sub-limits can curtail your health coverage

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The whole purpose of buying health insurance is to secure ourselves from financial losses during an accident or ailment. But merely buying one is not enough. We need to be extra careful while reading the terms and conditions and be aware of all the inclusions and exclusions. The last thing we would want during a medical emergency is learning that our health insurance plans does not provide us comprehensive coverage due to the sub-limits and we have to pay a massive amount from our savings. So, what are sub-limits?

1. What are Sub-Limits in Health Insurance?

Sub-limits, as the name hints, limit the health insurance coverage. It is a condition in the policy that states that the insurance company will bear the medical expenses only up to a certain limit. The remaining amount of the bill has to be paid to the policyholder. Sometimes, the sub-limit is presented in the form of a percentage of the sum insured, and on other occasions, it is a specific amount set by the insurer.

2. Different types of Sub-limits

The sub-limits don’t apply to the entire bill amount. They are generally reserved for special conditions like room rent charges or for the treatment of certain diseases. Here a few types of sub-limits:

• Sub-Limit on Treatment Of Specific Diseases: While the diseases mentioned in the policy may differ from one insurer to another, the clause is likely to mention that the insurer will pay about 80-90% of the bill or 1-2% of the sum insured. Usually, insurers mostly place sub-limits on pre-planned medical procedures such as cataract operation, knee ligament reconstruction, etc.
• Sub-Limit on Hospital Rent: Let’s say, the online health insurance plan you bought gives you a sum insured of Rs. 10 Lakh with the sub-limit on room rent being 1%. It means the reimbursement that you can claim on daily room rent is Rs. 10,000. In case, you opt for a room that costs Rs 12,000 per day, you will have to pay the remaining Rs. 2,000 per day. Similarly, there could be a cap on other facilities like consultation, ICU, oxygen supply, and ambulance charges among others.
• Sub Limit on Post Hospitalisation: There are ailments where the patients may not need to stay in the hospital, but have to go through the treatment at home. In such cases of surgeries or prolonged illnesses, hospitalisation, the insurance company offers to cover post-hospitalisation charges only to a certain sum. Courtesy the sub-limit, the policyholder will have to bear the remaining cost if and when the expenses exceed the agreed amount.

 

3. How to avoid or take precautions against Sub-limits?

There are three ways to go about it:

1. Read the document carefully and understand the sum-limit in each case from the insurance agent. If you are not happy with the terms, either look for another plan or another insurer who is willing to offer more benefits.
2. If you already have an insurance policy with a sub-limit, you can keep an eye on the mounting bills and ensure that your expenses are not crossing the threshold limit. A good start would be choosing a room that gets fully covered under insurance without reaching the sub-limits.
3. Buying health insurance plan online will help you get discounts as insurance companies can save on agent commissions and operational costs and pass on that benefit to the policyholder. Also, all the details about the sub-limits are available on the insurer’s website.

 

4. Importance of Sub-Limits in Health Insurance Policy

The role of sub-limits in health insurance is to keep the expenses in check and reduce unwarranted inflated medical bills. Let us say you have a high sum insured and now as a policyholder, you would like to take the maximum benefit of the policy by opting for better facilities. Now, if you are told that a small percentage of the medical bills will have to be paid by you once you cross a certain limit, you will be more mindful of the choices like the hospital room you are opting for. This also lowers the risk for the insurers by limiting their liability to pay to their customers. If you are wondering what advantage it has for the policyholder, well, the health insurance premium in a policy with sub-limits is more pocket-friendly.

 

Conclusion

An insurer can try to sell you a plan with sub-limits, but it’s ultimately your call if you want to opt for one to save some money on premiums or you want to pay more. But always buy a plan that provides comprehensive coverage so that you are covered fully against any medical emergencies.   

 

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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