Hospital room rental limits will be reflected in insurance claim amount

K. ARAVIND

Although health insurance policies are designed to cover hospital costs up to a certain amount, there are limits on expenses such as room rent, and the policyholder will have to bear the excess costs. Such limits are imposed to limit the liability of the insurance company in the event of a claim.

The room rental limit is the main condition that determines the insurance claim. Therefore, special attention should be paid to the terms of the policy in this regard.

Many policies allow a fixed percentage of the sum insured as the maximum room rent. For example, suppose the daily room rent is limited to one per cent of the sum insured. If the rent exceeds this limit, the policyholder will have to bear the amount above the limit on his own. In the case of a sum insured policy of Rs.1 lakh, if the room rent is more than Rs.1,000, the policyholder will have to pay a proportionate share of the other expenses incurred in the final bill.

Let us see how the room rent limit is reflected in the claim. Depending on what type of room is taken in the hospital, rent, examination fees, surgery costs, nursing fees, and other expenses are calculated. If the room goes above the rent limit, the insurance company will only pay a certain amount of the total claim amount.

For example, suppose you have a sum insured policy of Rs.3 lakhs and the ceiling of the slum is one per cent of the sum insured. That is, you can claim a maximum of Rs.3,000 in rent. At the same time, suppose the hospital gets a room with a rent of Rs.4,000. You will have to pay out of your own pocket Rs.1,000. If the total bill amount is Rs. 3 lakhs, only a proportionate claim will be received. The insurance company will only allow a claim of Rs.2.25 lakh depending on the room rent limit. The remaining Rs.75,000 will have to be paid from his own pocket.

There are several types of room rental policies available in the market. At the same time, the terms and conditions of the insurance policy vary from company to company. Most companies set a limit of up to a certain sum insured and do not set a limit on it.

Some companies set a limit on sum insured policies of less than Rs.5 lakh, but do not set a room rental limit on sum insured policies of Rs.5 lakh or more.