Last Update: February 11, 2023, 11:14 IST
Insurance companies place sub limits not only on diseases but also on certain services.
A sub-limit is a limit on how much insurance is covered by a policy.
Health insurance policies have become the need of the hour due to the high cost of medical treatment and often unaffordable medical expenses. While it is important to have a health insurance policy that covers any unforeseen medical emergencies, it is also important to understand the terms and conditions and jargon related to insurance properly. In case of confusion, you may fail to take full advantage of the insurance coverage. One thing that you should be well aware of is the sub-limit.
A sub-limit is a limit on how much insurance is covered by a policy. This cap is stated in the policy as a fixed cash amount. There are sub-limits for many conditions, drugs and services. The sub-limit is sometimes expressed as a percentage of the sum assured and at other times as a fixed amount.
Let’s say the cover amount of your policy is Rs 5 lakh. However, the policy has retained the lower limit for treatment of any disease. If the sub limit is Rs. 50,000 and your medical expenses increase to Rs. 100,000, in this case, the insurance provider will contribute only Rs. 50,000. Cause? The provider had already mentioned the sublimit for the treatment of that disease in the policy. Now, even if the sum assured of your policy is Rs. 5 lakh, you still have to pay the remaining Rs. 50,000 from your pocket.
Insurance companies place sub limits not only on diseases but also on certain services. Typically, this applies to a range of services, including hospital room rent, ICU charges, ambulance charges or OPD charges. For example, the insurance company may put a condition on hospital room rent keeping a sub-limit of Rs.3000 per day. If your hospital room rent is Rs 5000 per day, then the additional Rs 2000 per day cost is on your own.
The sub-limit can also be in percentage of the sum assured. Assuming your sum insured is Rs 5 lakh and the room rent sub-limit is 2% of the sum insured, you can claim up to Rs 10,000 as room rent.
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