Sub-Limit in Health Insurance

Health insurance sub-limits are critical when purchasing medical insurance. A health insurance policy with no sub-limits may be more expensive. This occurs due to a sub-limit reducing the insurance company's liability. The purpose of sub-limits is to control costs and reduce unjustified medical bills.

Assume you have a large sum insured and, as a policyholder, you want to get the most out of your policy by opting for better facilities. If you are told that you must pay a small percentage of the medical bills once you reach a certain threshold, you will be more cautious about the hospital room you choose. This also reduces the insurers' risk by limiting their liability to pay their customers. 

Sub-limits affect claims in many ways, such as:

• When there is a sub-limit, the final claim amount is reduced. For things like hospital room rent, treatments for certain diseases, or post-hospitalisation charges, you can only claim the amount specified by the sub-limit clause; you must pay anything above that.
• Even if you have a large sum insured, these sub-limit clauses can prevent you from claiming for all of your hospitalisation or treatment costs.
• Remember to carefully read these sub-limit clauses to avoid any last-minute confusion during the stressful period of hospitalisation or filing a claim. This way, you can be assured of a smooth claims process.

You can take the following precautions against sub-limits:

• Read the document carefully and understand the insurance agent's sum limit in each case. Then, if you are dissatisfied with the terms, look for another plan or insurer willing to provide more benefits.
• If you already have an insurance policy with a sub-limit, you can keep track of your expenses and ensure they do not exceed the threshold limit. An ideal place to start can be to select a fully insured room without surpassing the sub-limits.
• While buying health insurance online, you can save money on commissions and operational costs. In addition, all information about the sub-limits is available on the insurer's website.

Suppose you cannot afford a health insurance policy with no sub-limits. In that case, you must ensure that room rent and treatment costs for specific diseases listed in your policy are reimbursable before being admitted to a hospital.

• Before signing up for a health insurance policy, you should check the applicable sub-limits. If you believe that the policy's actual coverage falls short of your specific needs or healthcare costs, you can choose to increase your sum insured.
• Even if you have a large sum assured, you may be unable to claim your hospitalisation expenses in some cases due to the sub-limit clause.
• Furthermore, you should always be admitted to a network hospital listed by your insurance provider because the former's rate structure is generally consistent with the sub-limits specified in your insurance policy.