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What Are the Different Types of Sub-Limits Under Your Health Insurance Policy?

Health insurance policies are of prime importance in today’s day and age. With the soaring cost of medical treatment, it is necessary to have a financial safeguard. But not all health insurance plans are the same. Different health insurance plans have varying terms and conditions. That is why it is essential to thoroughly understand the implication of such terms and then purchase a health insurance policy.

What are sub-limits to a health insurance policy?

Among the many terms and conditions, sub-limit is one of which that needs special attention. As the name suggests, it limits the amount of expenses that you can claim. Thus, a policyholder may not be allowed to raise a claim the entire amount of that medical expenditure. It results in a higher amount that needs to be borne by you, the policyholder, when making a claim thereby increasing your out-of-pocket expenses. You must note that sub-limits do not exclude a particular category of expenditure entirely, but instead impose a capping on the compensation paid for such category of expenditure. Further, these sub-limits are not applicable on the entire bill amount but instead only a specific category of expenditure like room rent or on the treatment of certain diseases.

What are the different types of sub-limits?

There are three types of sub-limits that may be imposed in your health insurance policy.

Sub-limit on specific medical condition: With increasing instances of lifestyle diseases, there are many ailments that are commonly suffered by majority of the population in a specific age-group. To quantify it, almost three out of five individuals face them. High blood pressure, kidney stone, cataract, piles, gallstone, hernia, tonsils, knee ligament reconstruction, sinus are some to name a few. The insurance companies place a sub-limit on these procedures wherein only a specified amount of expenditure is covered by the insurance policy. For instance, the insurance company may specify a pre-defined amount of expenses or specified percentage of the sum insured for these treatments. The sub-limit on specific ailments is not only applicable to a claim settled via reimbursement mode, but also a cashless health insurance too. Any amount above such specified limits is required to be paid by you.

Sub-limit on room rent and other charges: Apart from specified expenditure, the terms of the policy may also specify a capping on the amount of expenditure admissible under the insurance policy. The most common case is capping on the room rent charges in case of hospitalisation. Here the insurance company limits the expenditure that can be claimed to a specified amount. Apart from room rent, there are other examples of similar sub-limit for expenditure which are doctor’s consultation charges, ICU charges, ambulance charges and even diagnostic tests.

Sub-limit on post-hospitalisation expenses: Not all treatments can be provided in the hospital itself. Some treatments require medication and other ancillary treatment to be followed up post main procedure. Thus, some insurance policies place a sub-limit on the amount of post-hospitalisation expenses. Any amount exceeding these post-hospitalisation costs shall be required to be borne by you.

Make sure to read the terms of your insurance policy specifying the sub-limits for various expenses. You should select a policy with higher amount sub-limit so that more expenses are covered by your insurance provider. Whether you are buying a individual plan or a critical illness policy, remember to account for these sub-limits to have maximum coverage.  Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.