Must know: Sub-limit clause on Medical Insurance
A sub-limit is a monetary cap that your insurance provider places on your medical insurance claim
Sub-limit on hospital room rent or certain treatments is something that you should understand the moment you take a health insurance policy. A sub-limit is a monetary cap that your insurance provider places on your medical insurance claim. Sub-limits can be placed on hospital room rent, doctor’s consultation fee, ambulance charges and a few pre-planned medical procedures such as cataract removal and knee ligament reconstruction. At times, even though your sum insured is high, but you may not be claiming your entire hospitalisation expenses due to the sublimit clause on specific medical procedures.
Impact: If your room rent cap in your insurance plan is Rs 3,000 per day and you opt for a room that costs Rs 5,000 per day, you will have to pay the difference of Rs 2,000 from your pocket. Likewise, if there is a sub limit clause of 50% of sum assured for cancer treatment, then even if your total sum assured is Rs 10 lakh, you cannot claim more than Rs 5 lakh due to the sub limit clause.
Read: Health Check