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Health Insurance | Room Rent Limit In Health Insurance - Greyfont


 

Room Rent Limit in Health Insurance

 

- These are two friends out on a drive…

- Unfortunately they meet with an accident

- Both of them were hospitalized and are back home happy and healthy

- But Karan is still not happy!

- Ask him why?

- He says he is not happy with his insurer as they have not offered him full coverage

 

Sum Insured

Room rent limit

Actual room rent limit

Bill

Arjun

5 lakhs

No room rent limit
 

5,000

1.5 lakhs

Karan

5 lakhs

Rs. 3, 500
 

5,000

1. 5 lakhs

 

- Rs 1.5 Lacs – 1500 * 6 days = Rs 1.41 Lacs.

- Actually, that’s not true.

- The reimbursed amount will be Rs 1.5 Lacs * 3500/5000, which equals to Rs 1.05 Lacs

 

Why? This is because of Room Rent limit!

 

Yes, Room Rent limit can make a whole lot of difference during the claim settlement process. It can fetch you not even half the amount that you are claiming for as the hospital charges you on the type of room you prefer to opt for. Different rooms in a hospital have varied room rent limit which can drastically affect your claims as the medical expenses differ for each of these rooms.

 

While buying a health insurance policy, one has to check on the room rent limit as it plays a crucial role in your claim settlement. Even if you have a high coverage amount then too your insurer can pay you less amount all because you have crossed the limit on your room rent.

 

But first, let’s understand what Room Rent limit is?

 

To put it simply, Room Rent is  limit set on the type of room you can occupy in a hospital on a 24 hour basis; it is just the maximum limit that will be borne by the insurer when you are hospitalized.  This limit comes with a maximum cap limit that can be restricted, irrespective of the sum insure you opt for. This means that even if you have a high sum insured, then the insurance can pay less amount during hospitalization and the rest of the expenses will have to be borne by you. Ideally, room rent limit is capped at 1% of the sum insured  in health insurance. Hospital room that you opt for and the rising medical costs have a huge impact on the room rent limit.

 

Does Room Rent Have an Impact on the charges you pay in the hospital?

 

It is important to note that doctor’s fees, operational charges, nursing expenses and other medical costs and others are completely dependent on the type of room you opt for.  You will be charged on a per day basis for staying in a hospital.

 

The medical costs for a person staying in a deluxe AC room would be high compared to someone staying in private room.

 

Consider the below example

 

Room Type

General

Shared

Deluxe

Charges of the room

2000

3000

5000

Cost of ailment-example heart attack

90000

1,45,000

2,30,000

 

Does Room Rent Limit Have an Impact on Health Insurance?

 

Yes, it surely can as the charges of your insurance claim are directly linked to your room rent limit.

 

Consider this,

The cost of hospitalization charges for a person staying in different rooms.

Consider that your sum insured is 3 lacs and room rent limit is Rs. 2,000.

 

Room Type

General

Shared

Private Deluxe

Room rent

2000

3000

5000

Cost of heart surgery

90000

1,45,000

2,15,000

Other expenses

40,000

80,000

1,20,000

Total Expenses

1,32,000

2,28,000

3,40,000

Insurance Company pays

1,32,000

1,32,000

1,32,000

 

0

96000

2,08,000

 

With the above example, it can be clearly understood that the charges of a deluxe room and shared room would make the policyholder liable to pay from his own pocket as he/she has exceeded the mentioned room limit of Rs. 2000.

 

This results in partial payment and the balance payment has to be borne by the policyholder, giving rise to customer dissatisfaction and grievances.

 

Since room rent limit plays an essential role in your insurance company offering you full coverage, it’s essential you opt for a plan with no room rent limit or a high room rent limit to ensure you don’t have to bear the additional costs. Also, with this, always go through the policy wordings carefully as other factors too can affect your claim settlement process.




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