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What is the Concept of Room Rent Limit in Health Insurance?

Posted On : 12 April 2021, 3 Years Ago. Health-Insurance Total Read 1604

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While the concept of healthy living has been catching up in India, there is no escaping the fact that a number of diseases are on the rise. A combination of sedentary lifestyles, pollution and poor nutrition has resulted in a significant increase in illnesses. As per a report by the Centre for Science and Environment (CSE), air pollution is the reason behind 30% of premature deaths in the country. A gradual increase in the cost of medical care has aggravated the situation. With the number of diseases rising on one hand and an increase in the cost of healthcare on the other, the benefits of health insurance cannot be overstated.

While more and more people are opting for health insurance these days, the focus remains on the size of the coverage. The size of the cover is important, but other aspects of an insurance policy like co-pay amount, network hospitals and health insurance room rent limit should also be taken into consideration. Benefits like free annual checkups are well-known, but many people are not aware of the room rent limit in health insurance.

What is the Room Rent Limit?

From a few large hospitals a couple of decades ago to several multispecialty hospitals in every major city now, the healthcare industry has come a long way in India. The options for people seeking treatment has increased manifold. Hospitals have different types of rooms and the room rent varies for each type. The room rent varies depending on the occupancy and the facilities being offered. A twin-sharing room in a hospital will naturally be less expensive than a single-occupancy room. The choice of the room rests entirely on the policyholders, but one should know about the room rent limit in health insurance.

The room rent limit is the amount up to which the insurer will cover the cost of the room. For instance, your health insurance policy has a room rent limit of Rs 1500 and the hospital is charging Rs 2000 per day for a room, the insurer will pay only Rs 1,500 and you will have to pay Rs 500 from your pocket. The amount to be paid out-of-pocket may not seem much, but it has to be noted that it is the additional amount you will have to pay every day. For a hospitalization of eight days, the out-of-pocket expense for the room will amount to Rs 4000.

Room Rent Limit and Insurance Claim

Even though the health insurance room rent limit applies to the daily cost of the room, it has wider relevance for the policyholder. Many people are not aware of the fact that the cost of the treatment is directly proportional to the room rent. Expenses such as nursing charges, cost of surgery and doctor’s visiting fees increase depending on the type of room opted by the policyholder. If you have opted for a twin sharing room and will have to pay Rs 15,000 for a certain procedure, the same treatment may cost you Rs 25,000 in a deluxe room. Hospitals charge on the basis of the paying capacity of the patient.

It is clear that the room rent has an impact on the overall cost of the treatment. Does the room rent limit also affect the claim amount? If you have a health insurance policy that does not have any sub-limits on the room rent, and you choose a deluxe room, the insurer will cover the entire cost of the treatment, including the room rent. However, if your policy has capped room rent, the reimbursement will be calculated in proportion to the room rent limit to the actual rent.

One should always keep in mind the overall treatment cost while choosing the room.

Types of Room Rent Coverage

Health insurance companies offer a variety of room rent coverage. There are four major types of room rent coverage common in India.

1. Room Rent Without Sub-Limits

These types of health insurance plans do not have any sub-limit on the room rent. The policyholder has complete freedom in choosing the type of room. Since there are no sub-limits on room rent, the insurer covers the entire treatment bill. The policyholder can choose a general ward or a deluxe room without worrying about the reimbursement.

2. Room Rent with Co-Payment

Certain policies have room rent limits with co-payment. The policy specifies an amount up to which the cost of the room is covered, and the policyholder has to pay out-of-pocket if the room rent exceeds the limit. The co-payment feature reduces the financial liability of the insurer.

3. Room Rent with Specified Room Types

These types of health insurance plan specify the room type for hospitalization. The policyholder can only opt for the rooms specified in the policy.

4. Room Rent Without Sub-Limits as an Add on Coverage

Some policies give you the option to remove the room rent limit, but it is offered as an add on coverage. It is not a default feature, but the policyholder can remove the sub-limit by paying an additional amount.

Conclusion

Many people just opt for the room that is available, but it can affect the claim amount. It is important to give proper thought before making any decision on the type of room. Alternatively, you can choose a health insurance plan or group health plan from a credible insurer that has a large number of hospitals in its network. Niva Bupa Health Insurance has a network of over 7000 cashless hospitals across India. Niva Bupa Health Insurance’s extensive network and quick claims process ensure that you remain tension-free even during emergencies.

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