Is your health insurance plan taking care of room rent?

With rising complexities, pollution levels, ecological imbalance, stressful life style etc. buying health insurance plan has become the most important purchase of your basket. However, almost all health insurance policies do come with sub-limits inbuilt into the plan. No matter how much coverage one has, the claim happens as per the sub-limits criteria. The doctors’ fees, surgery, operations, nursing expense, medicine cost including room rent, all have a specific cap called the sub-limit. Sub-limits for each admissible hospital expense are usually defined as a percentage of the sum insured. However, the most important hit that customer get is on the room rent. For example, if the room rent is capped at 1 per cent of sum insured then for a policy of Rs 1 lakh, room rent will be restricted to Rs 1,000.

Inspite of such low sub-limits, room-rent are highly ignored and played down by insurers at large. Often policyholders get big setback if they receive partial claim amount inspite of paying full premiums as set on time and taking a good coverage required for them. The reason could lie in the ‘room rent’ adjustment leading to partial claims. Not only this, one might have to pay from out-of-pocket because of the ‘room-rent’ clause.

The article guide customers on the hit on room rent rider of their health insurance plan and some ways to avoid them.  Problem arises if the hospital doesn’t have a room available at that price or when the policyholder wishes to occupy a room with higher rent. On taking the room of a higher value, there could be a negative impact on one’s claim amount. The claim amount of all hospital expenses such as medicine, doctors’ fees, operation charges etc. may get reduced proportionately. Experts say if an insured individual decides to opt for a room rent higher than the permissible limit under the policy, then a proportionate reduction is applicable to all other associated medical expenses and it has to be borne by the insured person.

People are always lured with benefits but are kept hidden from losses in policy document. The impact of room rent on other expenses if the limit is breached is something not very explicitly mentioned and disclosed on the brochure of products. This clause is stated in the policy document and therefore you should give a careful reading of all such elements before purchasing your plan. Some new health plans are available in which on paying an additional premium, sub-limits itself may be removed. As far as coverage is concerned, go for higher sum insured and ensure you stick to your room-rent limit

Room rent plays an important part in claim settlement; it requires a more prominent upfront disclosure for better customer experience. Important information should come upfront at least in the brochure. With health insurance plans getting more varied, it’s important that the regulator and insurance companies relook at them to make it more customer-centric and friendly.

Recommendation

Do consider the option of porting to a policy options that has no caps or maybe offers room category capping instead of the one offering room rent limit. Do check if they’re are available at your age or health condition. In case you want to continue with a policy that has room rent limit, explore options of upgrading the insurance cover to at least sum insured of Rs. 8-10 Lakhs. It will protect you against high inflation and impairment of your overall coverage. While buying fresh policies, go for the ones that cap the room type or category. This will ensure you have clarity on what kind of room will always be available to you, irrespective of the per day charges. The entire experience of being in a hospital is itself is stressful and sickening. Being forced to compromise on a room lowers than your expectations or paying a big deduction on the claim are both unwanted pain. So, ensure you check your existing health insurance plan you are buying for room rent capping that could impair your coverage in the long run.