Understand sub-limit in your health insurance policy
Understand sub-limit in your health insurance policy
Posted On : 04 March 2021, 6 Months Ago. Health-Insurance
Article Header

Purchasing health insurance could offer you a number of benefits, and in today’s day and age it is considered to be a necessity by most people. Through periodic premium payments, you can provide yourself and your family (based on the type of health insurance plan you choose) with a medical cover up to a certain limit. In the event of a health or medical emergency, you can avail this cover.

With time, the market has evolved to recognise the wide range of demand as far as health insurance goes. Customers have different budgets, requirements, health conditions and family setups, each of which demands different features from their health insurance. As a result, the market has evolved to offer a wide variety of health insurance plans that vary based on price, tenure and coverage to suit the specific needs of customers. As a result of this, however, when you are looking for health insurance, you might find it difficult to identify which health insurance plan is the best option for you. In order to make a more informed decision, one might want to do some further research on the features of health insurance. This article will break down one such feature known as sub-limit in health insurance, explain sub-limit meaning in health insurance, and offer tips on what to look out for in your health insurance sub-limit.


What is issue-limit in health insurance?


As part of your health insurance plan, you are offered a number of features such as coverage for hospitalization charges, pre and post hospitalization charges, ambulance costs as well as the costs incurred from consultations etc. sub-limit in health insurance in the simplest terms, is a maximum limit placed on a given offering in your health insurance plan.

Let’s say for instance, you purchase a certain health insurance plan that covers your hospitalization room charges. While the insurance policy might cover some room charges, the presence of a sub-limit means that the charge per day for a room that the policy provider will pay is capped. If the charge per day for the room is 4,000 rupees, but the health insurance sub-limit on room fees is 3,000, then you as the customer will be required to pay for the remaining 1,000 per day for the room.

It is most common for health insurance companies to place sub-limits on two facets of their health insurance plan; the hospital room fees and the coverage offered against certain diseases. While there are provisions made for customers to circumvent the sub-limit, this comes at the cost of a higher premium rate.


There are two broad types of sub-limits in health insurance - 


1. The first is a fixed rate, meaning due to the sub-limit, the insurance provider will only offer coverage up to a certain amount that is pre-agreed upon. This means that regardless of the complete value of the medical bill, this sub-limit value remains fixed.


2. The second type of sub-limit in health insurance is based on a percentage of the total amount. For instance, a health insurance sub-limit could cap the hospital room charges to 2% of the total sum insured. This means that any room charges beyond 2% of the total sum insured will not be accounted for by the insurance provider.





Sub-limits in health insurance is an important condition for insurance companies, as it helps reduce the risk they take by offering health insurance. However, it is something that you need to keep in mind while choosing your health insurance. Generally, sub-limits are based on factors such as the payments for some high-risk diseases. These are considered high risk for health insurance companies as the variability factor is too steep. As someone looking to understand the sub-limit meaning in health insurance in order to make a better choice of plan, one must always carefully check sub-limit clauses of health insurance policies so that later they are not faced with costs they did not anticipate beforehand.







Secure your health with comprehensive insurance plans from Maxbupa

Tell us a bit about you

Whom are you buying for ?
Myself Icon Individual
Wife Icon Husband & Wife
Family Icon Family
Enter valid name
Enter Valid DOB
OTP sent Resend OTP
otp icon
OTP Expires in
I authorize Max Bupa to call me. This will override your existing registry in DNCR. I want to get my quote and policy details on WhatsApp.