Sub Limit in Health Insurance

Breaking Down Sub Limits in Health Insurance Plans

Several considerations should be made while purchasing a Health Insurance policy. Sub-limit is one of the unnoticed components in this. A sublimit in health insurance must be considered every time you buy a mediclaim policy. It is a pre-determined cap on specific medical costs and is usually a certain percentage of the sum insured. A person should buy a mediclaim policy that comes without a sub-limit so that the person can raise a claim up to the sum insured amount.

Before jumping to the sublimit, one should know about: what is a Defined Limit in Health Insurance? So, let’s explore this term.

What is the defined limit in health insurance?

A defined limit in health insurance refers to a cap on the amount an insurer will pay for specific medical expenses or the total amount of claims a policyholder incurs before the insurer starts covering costs. These limits can be sub-limits on particular items like room rent or surgical procedures, or a deductible.

What is a sub-limit?

A sub-limit is a cap on the maximum sum insured can be paid up to a certain limit. The insurer will not be liable to pay beyond it. the Sub-limits. The Sub-limit. It is inclusive of the medical expenses incurred.

We have seen: What is the sublimit in health insurance? Let’s discuss its various types.

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Types of Sub-Limit Health Insurance in India

Sub-limit health insurance in India can be classified into the following types, broadly speaking:

1. Disease-Specific Sub-Limits

This sub-limit refers to some diseases or medical conditions. Some examples are:

• Cardiac Conditions: A policy may carry a sub-limit on heart surgeries covered only up to ₹ three lakhs.
• Treatments for Cancer: Chemotherapy or radiation therapy might come under sub-limit and claims would only be covered up to a specified sum.
• Orthopaedic Procedures: Those related to joint replacement or fractures may have a cap.

2. Room Rent Sub-Limits

There are mostly caps on the rent of the room, which can be claimed while in the hospital. For example, if a policy has allowed a room rent of ₹2,500 per day, there can be a limit by the insurer on claiming treatment in higher-category rooms like private or deluxe rooms. This reduces the overall coverage available, as higher room rents than admissible may invite proportionate deductions across the bill, which reduces the overall admissible claim amount

3. Procedure-Specific Sub-Limits

In some procedures, sub-limits can be independent of the total amount insured. Thus, for example, it may happen that a policy might specify that ₹1.5 lakh is all that can be claimed for surgery like laparoscopic cholecystectomy. If the cost incurred happens to exceed that limit, the excess has to be paid by the policyholder himself.

4. Sub-Limits as Related to the Insured's Age

Some policies limit based on the age of the insured. For older persons, the treatments may be capped at lower limits, reflecting the higher risk involved with that age group.

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5. Network Hospital Sub-Limits

Some insurance companies might have special tie-ups with the network hospitals and, there are sub-limits for the treatments availed of in the network hospitals. Though that sometimes results in cashless treatment, still one needs to be cognizant of the claims submitted being capped off.

Advantages of Sub-Limit Health Insurance

Whereas sub-limits have their drawbacks, they also have several merits that come with them:

1. Lower Premiums

Policies containing sub-limits are less costly than comprehensive policies with no sub-limits. That is why they appeal to individuals living on tight budgets who are looking for affordable health insurance coverage.

2. Encouragement of Frugal Treatments

Through sub-limits, insurers encourage the policyholders to opt for inexpensive treatments and avoid unnecessary procedures. In this way, the total healthcare spend can be reduced.

3. Greater Overall Coverage

Sub-limits sometimes provide the insured with greater overall coverage amounts. Although they limit certain treatments, insurers will have better control over risks and thus offer greater overall coverage amounts to cater to other medical requirements.

Important Factors in Choosing Sub-Limit Health Insurance

Sub-limits in medical insurance are the most important factor that one should prioritise while buying a health policy, but it is even more important to look at the factors that come into play while selecting a sub-limit. Let’s discuss here:

1. Understand the Sub-Limits

Before you buy one, read the terms and conditions of each carefully in order to look into the sub-limits imposed on different treatments. This will help you measure the genuineness of the coverage for your specific health needs.

2. Measure Your Health Needs

You should consider your health history or any pre-existing condition. If you have a chronic illness, which requires regular treatments, you may opt for a policy that has fewer or higher sub-limits.

3. Compare Different Policies

Not all health insurance plans are the same. Use the internet to compare various insurers and their sub-limit plans. See what your clients or friends have to say in terms of ratings and claim settlement records.

4. Room Rent Limitations

Be very careful with regard to room rent. It may shave off a large portion of the claim amount. If you want hospitalisation in private rooms or higher room category, make sure your policy has satisfactory coverage in that category and within sub limits.

5. Future Needs

Health insurance is never solely a present-day need. It is future-forward thinking. Consider how your medical needs are likely to evolve over time and whether the policy will work well for you over the years.

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Summing up

Most Health Insurance companies provide various coverage, including modern treatments, AYUSH treatments, etc., with sub-limits. Make sure to check the sub-limits before opting for a Health Insurance plan. You should always purchase no sub limit health insurance so that you can raise a claim up to the sum insured amount.