What’s a Sub-limit in Health Insurance?

Health insurance has become essential these days with growing cases of casualties and a rise in lifestyle diseases. To stay protected financially, it is vital to select the right cover. When buying the right cover, certain factors need to be considered as well. There are some insurance jargon that may confuse you with their weird appearance or names. One such jargon is Sublimit.

Sublimit tends to be underrated feature of health insurance; even it plays an important role in deciding the right policy. Let’s decode it here:

What’s a Sub Limit?

A sub-limit clause is set by every health insurer on the expenses incurred by the policyholder. It is a cap on specific medical expenses such a hospital room rent, medicines, doctor’s consultation fee, ambulance charge or for some specific diseases. With a sub-limit clause, the insured can’t claim beyond the limit

However, the sub-limit clause may vary from insurer to insurer. At times, sub-limit may be a defined percentage of the total sum insured while, in some other cases, it can be a precise amount pre-defined by the insurance provider. Usually, the ICU charges and room rent are subjected to 2% and 1% sub-limit respectively of the actual sum insured.

Types of Sub Limits

A sub-limit can be of two different types:

1. Illness-Specific Sub-Limit: 

With this sub-limit, the insurer imposes a cap on certain ailments. The diseases including sinus, tonsils, hernia, kidney stones, knee ligament reconstruction, cataract removal, piles and many more. The list of ailments and the monetary cap on each of the treatments vary from one insured to another. Most of the time, insurers may impose sub-limit on doctor’s consultation fee as well.

2. Hospital Room Rent Sub-Limit

Health insurers come with a sub-limit clause for the amount they have to pay against a claim arising for the room rent expenses you may have incurred during hospitalisation. Let’s say if your health insurance of Rs. 5 lakh comes with 1% of sub-limit on hospital room, expenses up to Rs. 5000 will be approved by the insurer. For any amount beyond this will be borne by you. So, with such a sub-limit the insurance provider is liable to pay up to the permissible limit and the insured will have to pay the amount exceeding the limit.

3. How does it Effect on Health Insurance Premium?

By opting for a sub-limit clause with your regular health insurance, you can save on premiums. A health insurance policy with no sub-limit demands a higher premium than the one with sub-limit. Thus, health insurance experts suggest selecting a cover wisely. However, don’t forget that coverage with sub-limits will anyhow provide limited coverage.

Final Word!
 

A sub-limit is one of the vital features to assess health insurance. A health insurance plan with no sub-limits may ask for a higher premium. Well, be careful while deciding on the plan with sub-limits. Say yes to a plan that comes with comparatively a lower sub-limit on room rent or specific illnesses. This way you can save on the out-of-pocket expenses and stay protected fully.