With rising medical costs, purchasing a health insurance mediclaim policy has become an integral investment. Due to the varied medical needs of consumers, different types of health policies are available, such as senior citizen health insurance, maternity insurance and more.
However, purchasing a health insurance plan is not enough if you are unfamiliar with health insurance terms such as waiting period, coverage limit, and maximum age for health insurance. Understanding these terms and concepts is important to fully take advantage of your health plan.
The coverage limit is a crucial factor in a health insurance policy, which we shall understand in this blog.
What are Health Insurance Coverage Limits?
The health insurance coverage limit is the predetermined cap or limit on the specific medical insurance plan. It means the insurance company will pay up to the decided coverage limit for the policy tenure for health emergencies.
Once that coverage limit is reached, the policyholder must pay for the additional expenses out of their pocket. The coverage limits are generally decided at the time of policy purchase based on the health insurance plan chosen.
Health insurance limits are generally classified based on coverage and policy tenures, such as the annual limit for a one-year policy and the sub-limit for specific covered services.
Understanding of Sub-Limits in Health Insurance Limits
A sub-limit is basically the extra limit to health insurance policy coverage for a specific medical service. The specific medical service is part of the original policy coverage limit.
However, to limit its liability at the time of claim, insurance companies place a monetary cap by including a sub-limit. It means individuals can claim up to predetermined limits on specific medical expenses.
Sub-limits can be put on doctor consultations, ambulance charges, hospital room rent, and more. They are also utilised for some medical procedures, such as knee ligament reconstruction and cataract removal.
Types of Sub-limits in Health Insurance Online
There are different types of sub-limits offered under health insurance online. Let’s understand the prominent sub-limit in health insurance mediclaim policy.
Sub Limit on Room Rent
Under this category, the health insurance plan will cover hospital room rent expenses per day but only up to a pre-decided amount. If the individual room rent bills go above the specified amount, then they need to pay for room rent expenses out of their own pocket.
For example:
Mr. A has a health insurance policy with a sum insured of ₹5,00,000. Within this policy, there is a sub-limit of ₹50,000 for room rent per day during hospitalisation. If he opts for a room that costs ₹10,000 per day, the insurance company will only cover up to the sub-limit of ₹50,000 for room rent, regardless of the number of days he stays in the hospital.
Sub-limit on Specific Treatments
Under the specific treatment sub-limit, the insurance provider places a predetermined limit on the treatment of certain medical illnesses. Even if the sum insured for the health insurance plan is high, individuals cannot claim the hospitalisation expenses for certain medical illnesses with a sub-limit.
Thing to Look For While Choosing the Health Insurance Plan
While buying health insurance online, individuals need to consider some points to make an informed decision.
Coverage Benefits: The first thing to check while looking for an online medical policy is the coverage offered under the plan. Most insurance plans come with basic health insurance coverage, but it is best to look for a plan that has unique coverage suited as per your needs.
This can be done by assessing an individual’s requirements. For instance, if an individual is planning to have kids, then choosing a health insurance plan with maternity coverage is a suitable option.
Coverage Limit: The coverage limit is the maximum amount insurance providers will pay for medical expenses during the policy tenure. It is generally decided based on the individual health requirement. It is best to look for a plan that offers decent coverage for medical expenses for policy tenure.
Sub-limit: Another thing individuals need to look for while choosing a health policy is a sub-limit. It is the predetermined limit for certain medical expenses such as ambulance charges, hospital room rent, and more. Beyond the limit, the policyholder needs to pay out of their pocket for these services.
Customisation Option: Another thing to look for while choosing a health insurance plan is customisation option. This means individuals will have the flexibility to customise their plans based on their health requirements.
Waiting Period: Lastly, always check the waiting period of the health insurance policy. The waiting period is the specified time duration during which no claim can be made or benefits can be availed under the health insurance policy.
After the waiting period is over, individuals can avail themselves of the plan benefits. The waiting period may vary depending on the person’s medical history and insurance provider.
Conclusion
Knowing the health insurance coverage limit while purchasing an insurance plan is crucial. It will help policyholders understand the medical coverage for a policy tenure. However, at the time of purchasing the plan, it is best to compare health insurance policies based on coverage limit to choose the best plan that fits the requirements.