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Everything You Need to Know About Sub-Limits in Health Insurance


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Having health insurance in today’s day and age has become incredibly important due to the increasing medical fees. Health insurance provides coverage to the insured individual in case of medical or surgical emergencies. Choosing between various health insurance plans in India is not an easy decision. When you are buying health insurance, you need to keep some factors in mind so that you get the best insurance policy in the market such as sub-limits. ‘A sub-limit is an extra limit in an insurance policy’s coverage of certain losses.’ Sub-limits are a way that the insurance company limits its liabilities. Health insurance plans in India that do not have sub-limits cost more than those that do. Sub-limits are usually places on hospital room rent, consultation fees, ambulance charges, and some medical procedures that are pre-planned.

Sub-limits are incredibly important in health insurance. Usually, they are a fixed value for a particular illness, disease, or treatment. However, they can also be a percentage of the total insurance sum. Insurers who provide health insurance plans in India put sub-limits on the hospital room rent and the sum that is pre-decided for specific diseases. The insured individual is sometimes given the option of opting out of the sub-limits. However, health insurance plans in India without sub-limits have a higher premium.

The two main sub-limits are:

  • Sub-limit on room rent: Under this sub-limit, the insurance company pays for the room rent per day. Most of the time, the insurance company includes either a general room or a semi-private room in its plan. A private room would cost more and you would have to pay out of your own pocket. Hospital charges are also directly related to the room you are staying in. For example, if you take a private room, doctor’s consultation fees, surgical procedures, etc. would probably cost more than if you were in a semi-private or general room.
  • Sub-limit on a specific treatment: Check the list of diseases and illnesses that are included under the sub-limits clause before you buy a policy with a sub-limit on a specific treatment. You cannot get the entire amount for treatment or hospitalization after a claim if there is a sub-limit clause. For example, if the cost of treatment for lung cancer is INR 20 lakhs and it is specified in the plan that the insurance company will only pay 50 percent of the total sum, then the insurance company pays only INR 10 lakhs. The remaining INR 10 lakhs has to be paid by the insured individual.

It is very important for the insured individual to be aware of sub-limit clauses and pick those policies that do not have clauses that will not benefit them. The good news is, health insurance plans in India have health insurance tax benefits as well. So, whether you opt for sub-limits or not, buying a health insurance plan will benefit you in every way. We hope this article was insightful. Good luck and stay healthy!