What are Sub Limits in Health Insurance ?

Having taken the decision to take health insurance to protect yourself and your families from expenses that might arise from any untoward health emergency is only half job well done. Buying a health insurance that suits your needs and is able to meet the objectives is of paramount importance. Health insurance plans have features which include day care procedures, co-payment clause, cashless cover and waiting period and exclusions that one needs to take care of before zoning on a final health plan.

Sub-Limits in Health Insurance plans means the limits that are imposed by the health insurance provider on the payment of sum assured when a claim is raised by the policyholder due to treatment of any medical condition. It is a monetary limit place by the insurance provider on medical insurance claim. These limits are placed on hospital room rent, ambulance charges, nursing and doctor’s charges, cataract removal, knee replacement charges etc.

Why Understanding Sub-Limit in Health Insurance Policy is Important:

Identifying and Understanding the Sub-Limits in Health Insurance is a critical aspect in choosing the health insurance plan. Incomplete awareness and understanding of this aspect can lead to a major shock or you may be unprepared to meet the costs of treatment. Sub-Limits are usually mentioned as a fixed value for treatment of any particular disease/illness or can also be expressed as a percentage of Sum Assured for specific diseases. Health Insurance plans that have less/ no Sub-Limits have high premiums.

We will discuss two important Sub-Limits so that You Can Choose appropriate Health Insurance Plan:

  1. Sub-Limit on Room Rent:

The Room Rent Sub-Limit limits the liability of the health insurance provider to a certain amount or certain percentage of costs that are related to room expenses and also insurer can also place restriction on the type of room including general room or the semi-private room. If your room rent is Rs 8, 000 and the policy has sub-limit of Rs 4, 000 then the policyholder has to fork out Rs 4, 000 from his/her own pocket.

Most of the medical expenses that include doctors and nursing charges and surgical procedures or the operation theater charges also depend on the type of room the policyholder avails of therefore these expenses adds up to the cost and sub-limit further increases the difficulties of the policyholder. The policyholder needs to discuss the sub-limit clues with the insurance provider to be clear and to avoid any unwanted surprises at the time of claim settlement.

  1. Sub Limit on Specific Treatment:

Before you finalize on the health policy based keeping in mind sub-limit you need to checklist of diseases/ conditions which are listed in the sub-limit clause and also the limit on the costs that are associated with them. It is not possible to claim the entire cost for treatment/hospitalization if there are sub-limit clause even though the sum assured that has taken is high. If the sub-limit for the cancer treatment is Rs 15, 00,000 and the sub-limit clause states that in case of cancer treatment the health insurer would make payment up to 50% of the cost then the insurer would pay only Rs 7, 50, 000, the rest will have to be paid the policyholder.

Therefore for an assured and hassle-free claim settlement, the applicant needs to have a thorough understanding of Sub-Limit clauses and choose only those policies that do not have discomfiting clauses and is able to meet the budget and needs.

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InsureFinServe March 4, 2020 0 Comments

Planning to Buy Health Insurance in 2020? Take a look at Key Norms That Changed in 2019

2019 had been an eventful year for the health insurance sector. The industry witnessed several changes during this time. Are you someone planning to gift yourself and your loved ones the protective shield of medical insurance? If yes, you should know the rules that changed in 2019. The following are some helpful insights into the matter.

The Indian Scenario

According to Financial Express, India falls in the group of the least insured countries in the world. The newspaper reports that just 20% of the Indian population holds insurance protection. Business today calculates the penetration of insurance coverage in the country as 3.7 when compared with its GDP. It is less than the average in the world; 6.31%. Statistics show that health insurance is the sector that experiences maximum growth in the market; 35% annually. General insurance follows at 18% and life insurance at 12%.

Health insurance, according to experts, is the first thing one should have. And it should start from the month you begin earning on your own.

Given below are the changes you should be aware of when exploring health insurance plans:

1. You can pay your premiums in instalments

This is perhaps a historic move from the Insurance Development and Regulatory Authority of India. It asked insurance companies to let users pay their medical insurance premiums in instalments. You can pay your premium monthly, quarterly or half-yearly. But the free-look period is quite lower for both the options than their annual variant.

2. The authority asked insurers to tweak their policies in favour of customers

IRDAI has asked insurance agencies to declare the pre-existing diseases that won’t be covered for a stipulated time period after policy start date. Today, consumers have the right to declare the diseases contracted after three months of policy start date. Diseases such as Alzheimer’s, Parkinson’s or HIV/AIDS cannot be rejected outright.

3. Customers have the right to choose a third-party administrator

IRDAI now allows customers to choose a third-party administrator for their insurance requirements. It ensures that consumers can avail the best health insurance plan in the market. You can go for a TPA either at the time of buying coverage or while its renewal.

IRDAI has come up with the draft plan for standard insurance coverage. The scheme offers from INR50,000 to INR10,00,000. The minimum age to avail the protection is 18 years. The higher age is considered to be 65 years. The exciting thing is that the scheme offers the ability to renew for a lifetime. There exists no exit age-limit for a policy-holder. You are also eligible for the protection even when undergoing treatments in alternative therapies.

Finally, IRDAI has reduced the waiting period to file a claim. The waiting period is a time when you can’t file a claim for a particular disease. From now on, no insurer is allowed to specify a specific waiting period before filing a claim. The general standard is 30 days.

There is no excuse to ignore your own health and that of your loved ones. Even the best medical insurance available today is more affordable at present.

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InsureFinServe March 2, 2020 0 Comments
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