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Know How Sublimits Impact Your Health Insurance Plan Coverage

A health insurance policy is anon-skippable investment in 2022. Among the different plans that are available, selecting a policy needs to be a well thought process. While many buyers purchase policies without reading the terms carefully, it often gets them in trouble later on. Inconvenience by way of inadequate coverage, or even limitations in coverage are some examples when you buy a policy without understanding its terms.

What are sub-limits in medical insurance plans?

Sub-limits are terms that fix a ceiling on the admissible expenses under the insurance plan. When sub-limits come into the picture, you may not be able to claim the entire amount of expense from your insurer. Thus, any medical expense over and above these sub-limits will be required to be paid from your own pocket at the time of an insurance claim. *

Sub-limits are applicable for most insurance policies but are not applicable on the entire bill amount. Instead, they are limited only to a specific type of expense. Common examples of expenditures that have sub-limits to them are room rent charges, doctors’ consultation fees, post hospitalisation charges, etc. *

A policy that mentions sub-limits in its terms is definitely more affordable as it restricts the insurance company’s liability. However, you need to shoulder more expense during a claim. On the contrary, a policy without sub-limits allows you to seek treatment without any financial stress as the entire cost is covered by the insurance company.  *

Impact of sub-limits on health insurance coverage

  • The insurance company determines the sub-limits based on their estimation of the different treatment costs for various ailments. This way, based on the average charges for a particular part of the treatment, the insurance company avoids fraudulent claims. *
  • Be it an individual plan or a family medical insurance cover, room rent charges are the most common type of sub-limit that are a part of the policy terms. * Standard T&C Apply
  • Since the regulator, the Insurance Regulatory and Development Authority of India (IRDAI), does not have any specific guidelines for insurance companies on the quantum of sub-limit, every insurer has different sub-limits based on their own assessment. * You can visit the official website of IRDAI for further details.
  • Since sub-limits restrict the medical coverage of a health insurance plan, it hurts the most who are entirely dependent on the insurance plan to tackle the treatment cost. *
  • When sub-limits are included in your policy terms, you may be required to pay a certain portion of your claim that exceeds such sub-limits. *
  • As a policyholder, you must check how much coverage the policy offers after considering the sub-limits in your plan. Based on your family medical history and your budget, you can accordingly purchase a suitable insurance policy. *

* Standard T&C Apply

How to be cautious when buying a plan that has sub-limits?

Since these sub-limits are decided by each insurance company and not by the IRDAI, you must thoroughly understand them before making any purchase. Understanding how the sub-limits will lower your policy’s coverage is instrumental in deciding if the plan is the right fit for you or not. In this process, you can make use of a health insurance premium calculator that will aid in comparing different plans and finalise on one based on your requirements. You can visit the official website of IRDAI for further details. * Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.

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