What are sub-limits in a health insurance policy

These days, purchasing a wholesome health insurance policy has become almost mandatory. Not only does it save you critical amounts of money in case of health emergencies but it also makes sure your well being is not neglected in fear of high expenses of hospitals and health checkups. Thus, in these times, it is also important that we understand the terms and conditions of health insurance policies so as to be able to make the best decision when it comes to choosing one. Terms like critical illnesses, pre-existing conditions, co-payments, no claim bonus and sub-limits are important concepts to understand thoroughly. Among these, sub-limits are probably the most misunderstood or ambiguous term to many. So let us understand what this term actually means.

What are sub-limits?

A sub-limit in a health insurance policy refers to the maximum limit or the cap for the amount of money the insurer has put, for the holder of the policy to avail of in the event of specific medical procedures. This limit is always pre-determined and specified in the policy. In simple words, it is the total claim amount that is available to the policyholder for certain specific diseases or medical procedures. Most common places where sub-limits are applied consist of doctor consultation fees, ambulance costs, hospital room expenses, and medical procedures such as cataract operations, plastic surgeries, etc. The specific limit, of course, varies from policy to policy and thus, these limits are very important to analyse and understand before buying a health insurance policy to ascertain whether your medical history and risk factors are in sync with the specified sub-limits and the areas where they are being applied.

In most policies, you will find a sub-limit for ICU charges or hospital room expenses placed at around 2 to 1 per cent of the total sum insured. Which means, if your medical insurance has a total sum insured of 20 lakh, then according to the terms of the policy, you can avail of a hospital room with the maximum charge of Rs 20,000 per day. On the other hand, when sub-limits are applied to medical procedures, there are usually specified sum amounts. For example, in case of a ligament attachment surgery procedure, the insurer may set a sub-limit of Rs 30,000. In this case, this sub-limit means that the insurer will be paying a total of Rs 30,000 for the procedure regardless of the total cost of the same. Top health insurers like Reliance Health insurance offer much flexibility when it comes to these sub-limits. Some providers offer the option of an extra premium which lets you opt out of sub-limits. In general, this is applicable for two types of sub-limits.

1. Diseases or Procedure Specific Sub-Limit

This type of sub-limit is applicable to certain specific types of diseases and medical procedures. These include common ailments like cataract, kidney stones, sinus, tonsils, etc. Sub-limits on doctor consultation charges, ambulance charges, oxygen supply, anaesthetics charges, etc are also included in this type of sub-limits.

2. Hospital Room Expense specific Sub-Limit

This type of sub-limit specifies the amount available for hospital room charges. For rooms above the limit, the policyholder needs to bear the additional expenses by themselves.

I am Dipti Goel, Working in Digital Marketing Field from last 5 years. Expert in Finance field.