Room Rent Limit In Health Insurance
- Explore Room Rent Capping
- Proportionate Deductibles Concept
- Benefits of No room rent limit
When planning your vacation, we often find ourselves browsing the internet for pocket-friendly rooms. Apart from creating a budget for transport, food, and shopping, accommodation is among the most expensive things when travelling.
However, during a medical emergency, you do not have the luxury to look at room rents. Receiving quality health care and efficient assistance is what matters. On further analysis, you will find how room rents are one of the most important along with the treatments availed during hospitalization.
Health insurance has multiple elements that are misunderstood. In this article, we shed light on the concept of
Before we talk about room rent limits in health insurance let us understand the concept of sub-limits in health insurance.
In simple words, sub-limits are fixed percentages of your sum insured that your health insurance plan will bear for different medical care expenses. For example,
Room rent is the maximum amount your health insurance plan will reimburse or pay directly to the hospital for room rent during your hospitalization.
Let us understand this with an example
Mr. Brijesh is admitted for planned surgery in a network hospital for 4 days. Post-surgery Mr. Brijesh can opt between two hospital room categories
As per the health insurance plan purchased by Mr. Brijesh, the room rent limit is INR 3,000 which means the general ward is well within the room rent limit covered by the health plan.
However, if Mr. Brijesh opts for a Private AC room he exceeds the given room rent limit due to which his claim will be affected as per the proportionate clause in health insurance.
The proportionate deductible clause is applied by health insurance companies on room rent. It means that companies determine the excess room rent you paid over the sub-limit of your health plan.
Further, your health insurance provider will deduct a proportionate amount from other services availed by you during hospitalization such as
P.S. - We have explained the effects of the proportionate deductible clause on your overall claim settlement in the next segment.
Room rent limit in health insurance is carefully considered while settling health insurance claims. It is essential to stay within your room capping per day to avoid paying extra out of your pocket.
Let us understand this with an example
| Health Cover | INR 15 Lakhs |
| Room Rent Limit | INR 10,000 per day |
| Hospital Room Rent You Paid | INR 20,000 per day for 8 days = INR 1,60,000 |
| Other Hospitalization Expenses | INR 5,00,000 |
| Total Hospital Bill | INR 6.6 Lakhs |
| Claim Settled by Insurer | INR 3.3 Lakhs |
| Out Of Pocket Expenses Paid By You | INR 3.3 Lakhs |
Confusing right? Why did the health insurer only cover your hospital bill of INR 3.3 L when you have a health cover of INR 15 L?
Due to the proportionate deductible clause, your overall claim settlement is affected.
Since you opted to pay 50% of the room rent out of your pocket which indicates that you are capable of paying the rest of the medical care bill as well.
Now that we have discussed the concept of room rent limit, let us further understand the different types of room rents.
| Type Of Room Rent Limit | Explanation |
| Room rent with no sub-limits | Many health plans come without sub-limits giving you the freedom to choose any category of hospital room |
| Room Rent with Co-Pay | You and the insurance provider will share the expenses of the room rent |
| Room rent with capping on specific room types | Your health plan offers specific room rent capping on different kinds of rooms like deluxe suites, Private AC rooms, etc. |
| Room Rent With Capping | Health plans put a maximum amount on room rent that insurance holders can avail of |
| Room Rent Waiver | On adding a room rent waiver add-on the room rent capping set by your health insurance plan is removed |
Opting for health plans with no room rent limit has its perks which are listed below:
The concept of sub-limits is heavily misunderstood by many during the purchase of a health insurance plan. It is essential to understand the room rent limit in health insurance and if the proportionate deductible clause applies to your health insurance policy.
If yes, consider sticking to the sub-limits mentioned in your health insurance. Contact our insurance experts for further information on room rent capping and all the details associated with the same.
Room rent limit in health insurance refers to the maximum amount your health insurer is willing to pay during your hospitalization as mentioned in the policy clause.
Most commonly, room rent capping for most health insurance providers is at 1% or 2% of the sum insured. However, it varies from insurer to insurer. Do not forget to read the policy schedule to understand all the essential sub-limits.
According to the proportionate deductibles concept, if you exceed your room rent limit, all other expenses will also be calculated based on the formula of proportionate deductibles.
Proportionate deductibles = room rent eligible/room rent availed X 100
A health plan with no capping on room rent may have a higher premium but will provide you with peace of mind, flexibility to avail the best facilities while undergoing treatment, as well as better access to the best network hospitals.
Room rent waiver add-on can be purchased along with your base health plan which removes room rent capping from your health insurance policy. Thus, giving you the freedom to opt for any room category during hospitalization.
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Simran is an insurance expert with more than 3 years of experience in the industry. She may have all the answers to your insurance queries. With a background in Banking, she proactively helps her readers to stay on par with all the latest Insurance industry developments.
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