Sub-Limits in Health Insurance: Types, Significance & Things to Keep in Mind

Health insurance policies are crucial in today’s day and age. With an increasing number of health ailments, having a backup plan helps to safeguard your finances and keep monetary worries at bay. But with the numerous jargon used in describing the policy features, it can be an overwhelming experience, for new as well as experienced buyers. One such jargon that is commonly found across all medical insurance plans is the sub-limit. Here’s an article describing the meaning, its different types, significance and what you need to keep in mind when selecting a policy. 

What are sub-limits in health insurance plans?

Sub-limits in your medical insurance plan limits the coverage of your policy up to a specified amount of expense. Here, the insurance company places the onus on you, the policyholder, to bear the amount of expense over a specified limit thereby increasing the out-of-pocket component when making a claim. While it restricts the scope of insurance policy, a sub-limit is not applicable on the entire policy cover but only on specified expenses like room rent or for certain ailments. 

What are the different types of sub-limits?

Sub-limits are not blanket restrictions for the policy but are limited to specified expenditure. Let us look at the different types of sub-limits. 

  • Disease or treatment specific sub-limit: As the name suggests, these policy sub-limits are based on the treatment sought for specified ailments. Since a few ailments are common among most policy buyers, the insurance company places these treatment-specific sub-limits for such ailments. Blood pressure, planned procedures like plastic surgery, kidney stone, cataract, piles, gallstones, hernia, tonsils, sinus, etc. are some examples of sub-limits for ailments. 
  • Sub-limit for hospital rent: The most common type of sub-limit is the room rent sub-limit wherein the insurance company defines only a specified percentage or a fixed amount that shall be reimbursed as room rent charges. Apart from room rent, ICU charges, oxygen supply required during treatment, consultation charges, ambulance charges, and even diagnostic tests are some other types of sub-limits that may be found in your policy terms. 
  • Post-treatment sub-limits: Not all treatments are completed during the period of hospitalization. Some require you to seek medical treatment even after getting discharged. With a post-treatment sub-limit, the number of expenses covered by the insurer after hospitalization gets limited. 

What is the significance of sub-limits when selecting a policy?

Sub-limits are an essential component that helps in arriving at a decision of policy purchase or not. Be it reimbursement or cashless health insurance, a sub-limit ensures that aids in comparing the myriad plans among themselves. Moreover, with the use of sub-limits, the premium for your insurance policy can be lowered but you will require to pay a higher amount as an out-of-pocket expense at the time of claim. Not all types of health insurance policies have a sub-limit. It is an optional clause that you can opt for. Also, for a policy with no sub-limits, the premium amount will also be higher otherwise. 

What are the things to remember when opting for sub-limits?

Firstly, thoroughly understand how the sub-limit in your insurance policy works. This can help you come at a conclusion of selecting or skipping a particular insurance policy. For any clarification, you can contact your insurance company too. Next, when making a claim, check whether the amount is claimed is below the allowable expense under the sub-limit clause. Also, keep in mind that these sub-limits impact your final claim amount since a higher portion will be required to be paid by you. To the extent possible, try to avoid sub-limits to enjoy an all-around coverage from your health insurance policy. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale. 

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