Sub-Limits or Package Treatments in Health Insurance Policy

What Exactly are Packaged Treatments in Health Insurance?

Packaged treatments give you the ease to choose plans that will cater to your particular needs for treating specific ailments or to cater to your family requirements if there are any. You can opt for family floater plans, which will extend coverage to your entire family, usually covering yourself, spouse, dependent children and parents. These packaged plans are especially beneficial when anyone in the family falls sick or meets with an accident as the coverage amount can be used to treat any member of the family. Also, it extends benefits like a network of hospitals that you can visit to avail the services and cashless treatment among other services. Also, many insurance companies have started including packages for treatments, which are chosen on the basis of the selected hospital rooms. The package will include the cost of the treatment along with the room rents and hospitalisation expenses.

What Features Should a Packaged Treatment Plan Consist of?

Besides providing coverage for the ailments, a packaged treatment plan must provide essential coverage for other areas, which form a crucial part of your expenses. Thus before opting for any packages you must ensure that the plan covers pre and post hospitalisation expenses, takes care of your medical expenses and also has a good network of hospitals.

Why is it Important to Read the Fine Print?

Although packaged treatments are meant for your convenience over and above anything else, it is extremely important that you go through all the terms and conditions carefully before signing on the dotted line. Financial advisers stress upon the need to understand and read the fine print for a better understanding of the nitty gritties associated with each plan. The most crucial limitation of these plans is the imposition of a “sub limit”.

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Sub Limits - What are They?

Usually imposed on common ailments like kidney stone, cataract, sinus, piles etc., sub limit is a clause, which many insurance providers employ to restrict their outflow and eventually it eats into your claim. Basically, by using sub limit, a company puts a cap on the amount it will pay for a certain ailment and will not pay beyond the sub limit mentioned. Thus if the procedure costs more than the sub limit specified, you will have to shell out the remaining amount from your own pocket.

For e.g., let us assume Shubham has invested in an insurance plan worth 10 lakh rupees and requires a hernia operation. However, the sub-limit on a hernia procedure is Rs 35,000. Thus, if the hernia operation costs him Rs 1 lakh, he will only receive 35,000 and has to pay the remaining Rs 75,000 from his own pocket. Additionally, sub-limits are not only imposed on procedures but also on hospital room rents.

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Sub Limits on Room Rents

Health insurance companies usually have a cap of 1.5%-1% of the total sum assured on hospital room rents. So if you have an insurance policy worth 3 lakh rupees, you’re per day limit for each day of hospitalisation will be approximately Rs 3,000. If you choose a room that is more expensive than this, you will have to shell out the remaining amount from your pocket.

Concluding

So when you plan to go for a packaged treatment plan, it is crucial to read the terms and clauses carefully, and choose the package that guarantees you the rooms you prefer; otherwise, you may end up paying through your nose!