The hospital room rent is one of the most important components of health insurance. Your policy entitles you to a particular standard of the room as per the coverage limits. This room can be a general ward or a private room or even a deluxe room if you have higher coverage. The insurer would pay for your room’s rent within the policy limit. Let us look at how a cap on your hospital room rent affects your health insurance claim process.
Here are some possible scenarios you would experience if you buy a policy with a sub-limit on room rent:
- If you need a private ward, the fees of which exceed your policy limit, you will have to pay the additional amount out of your pocket and that too for the entire duration of hospital admission. Let us use an example for better understanding:
Suppose you have insurance coverage of ₹6 lakh, with a room rent limit of 1%. This means that you are entitled to a hospital room with a rent of ₹6000 per day. If you want to upgrade to a room that costs more than this, say ₹8000 a day, you will have to pay the extra amount of ₹2000 a day for the number of days that you are hospitalised and stay in that room.
- Your insurer may reduce the settlement amount from other heads. For example, if you were admitted to the Intensive Care Unit (ICU), they may make a proportionate deduction from your entitlement.
- They may also pay only a part of the doctor’s fees or other related expenses such as medicine and attendant charges to adjust the room rent.
Thus, it is essential to go through the policy document in detail when buying a policy. Note the terms and conditions, particularly for the room rent limit, as it would affect the final settlement amount.
Types of room rent capping or limits in health insurance
There are different types of room rent limits, and it differs from one policy to another. So, read the policy document carefully before buying insurance to avoid any confusion at a later time.
- No limit on room rent
Under this, the insurer does not restrict the room rent up to a certain amount. You can choose any room or upgrade it after getting admitted to the hospital.
- Provision of co-payment for room rent
Under co-payment, your insurer shares a percentage of the room rent during your hospital stay. The percentage would be mentioned on the policy document so that you know how much you will have to pay out of your pocket in case of hospitalisation.
- Room rent with a limit
This entitles you to up to a certain amount of money as room rent. If you choose a room with a higher rent, you will have to pay the additional amount out of your pocket.
- Room rent limit for specific rooms
Some insurers put a cap on room rent based on the room type—single or double occupancy, AC or non-AC and more. You can choose a room that has rent well within the policy coverage or another one by paying more.
- Add-on for waiving the room rent
You can buy an add-on along with your regular health insurance to waive the room rent limit. This would be a convenient option against paying a higher premium for an exhaustive coverage with a high room rent limit.
In the time of need, when you want the best medical facilities and comfort, you can avoid being limited by room rent capping by opting for health plans that do not have any room rent limit when buying the policy. Here’s what you can do:
- Get a new policy altogether
- Port your existing policy to one with no capping on room rent
A limit or capping on room rent may affect your final settlement amount when you file a claim. So, go through the policy document carefully before you choose to go for offline or online health insurance. In money matters, it is always better to be safe than sorry.
