Understand what is sub-limit in health insurance


16 Aug 2023

Exploring Sub-Limits: A Crucial Aspect of Health Insurance

Sub-limits in health insurance play a crucial role in determining how much amount will paid for certain medical expenses and understanding them is essential to ensure you're adequately covered when the need arises. In the realm of health insurance, there are numerous terms and conditions that policyholders need to be aware of to make informed decisions about their coverage. One such often misunderstood aspect is the concept of "sub-limits".

What are sub-limits in health insurance?

Sub-limits, also known as sub-limit in health insurance, are predetermined maximum limits set on specific medical procedures, treatments or services. These limits are a part of the overall sum insured provided by us. In simpler terms, if a medical expense falls within a sub-limit category, we will only cover expenses up to that predefined limit, even if your overall policy sum insured is higher.

How do sub-limits work?

Let's delve into how sub-limits function with an example. Imagine you have a health insurance policy with a sum insured of Rs. 100,000 and it includes a sub-limit of Rs. 5,000 for room rent expenses. If you're hospitalized and your room rent exceeds Rs. 5,000 per day, you would be responsible for paying the excess amount out of your pocket, even if the total hospital bill doesn't exceed the policy's overall sum insured. In this scenario, even though you have a substantial sum insured, the sub-limit affects the coverage for a specific expense category.

Types of sub-limits

  • Room rent limit

The sub-limit caps the amount an insurer will cover for room charges during hospitalization. This often extends to associated expenses like nursing charges and other room-related costs.

  • Specific illness or surgery

There may be sub-limits for specific medical conditions or surgeries. For instance, if your policy has a sub-limit of Rs. 2,000 for cataract surgery, the insurer will cover expenses related to the surgery up to that amount.

  • Doctor's fees

Some policies impose sub-limits on doctor's fees for various medical procedures. This means the insurer will cover doctor's fees up to a certain limit.

  • Diagnostic tests

Sub-limits might also apply to diagnostic tests, including radiology and pathology tests. These limits can impact the extent to which these tests are covered under your policy.

  • Alternative treatments

Some policies have sub-limits for alternative treatments like Ayurveda, Homeopathy or Unani.

Factors to consider

  • Policies with lower sub-limits often have lower premiums.

  • When selecting a hospital, be mindful of the room rent, as this can impact the amount you'll need to pay out of pocket if the room rent sub-limit is exceeded.

  • Check if sub-limits apply to treatments related to pre-existing conditions, as these expenses can be significant.

  • Consider potential medical procedures or treatments you might need in the future and ensure that the policy's sub-limits are sufficient for those scenarios.

In conclusion

Sub-limits are an integral part to buy health insurance online and understanding their implications is vital to making informed decisions about your coverage. It's essential to carefully read the terms and conditions about policies on kotak general insurance, assess your potential medical needs and strike a balance between affordability and adequate coverage. By doing so, you'll ensure that you're prepared to handle medical expenses without any unwelcome surprises stemming from sub-limits. Remember, the right policy with suitable sub-limits can provide you with peace of mind and financial security during times of medical emergencies.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.