Sub Limits in Your Health Insurance

You should buy a health insurance plan that comes with no sub-limits. Without sub-limits, you will be free to raise a claim up to the sum insured amount. You can go through the policy wordings to find out about any applicable sub-limits under the health plan.

Read More

Get ₹5 Lac Health Insurance starts @ ₹200/month*
Tax Benefitup to Rs.75,000
Save up to 12.5%* on 2 Year Payment Plans
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Get insured from the comfort of your home No medicals required
I am a

My name is

My number is

By clicking on ‘View Plans’ you, agreed to our Privacy Policy and Terms of use
Close
Back
I am a

My name is

My number is

Select Age

City Living in

    Popular Cities

    Do you have an existing illness or medical history?

    This helps us find plans that cover your condition and avoid claim rejection

    Get updates on WhatsApp

    What is your existing illness?

    Select all that apply

    When did you recover from Covid-19?

    Some plans are available only after a certain time

    What are Sub-limits in Health Insurance?

    A sub-limit is an extra limit to a health insurance policy coverage placed on certain medical expenses. These medical expenses are covered as a part of the original policy coverage limit, that is the sum insured. Your insurance company can limit its liability under specific covers by including sub-limits.

    In simpler terms, a sub-limit is a monetary cap that your insurance service provider places on your medical insurance claim for certain covers. They are usually expressed as a fixed value for a particular illness/disease/treatment but can also be included as a percentage of the total sum insured.

    Sub-limits can be placed on hospital room rent, doctor’s consultation fee, ambulance charges, and a few pre-planned medical procedures, such as cataract removal, knee ligament reconstruction, etc.

    Importance of a Sub-limit in a Health Insurance Policy

    A sub-limit is one of the critical features to evaluate in health insurance. A health insurance plan without sub-limits may cost you more as the plans with sub-limits are comparatively affordable. This happens because the liability of an insurance company reduces with the help of a sub-limit.

    In case you need basic medical insurance coverage and don’t want to spend a lot on premiums, then you must opt for a health plan with sub-limits.

    Disadvantages of Sub-limits in a Health Insurance Policy

    A health insurance plan without sub-limits allows you to avail coverage up to the sum insured limit. You do not need to check that the medical expenses, such as room rent and ambulance charges, are within the reimbursable limit of the policy before getting treated in a hospital.

    Thus, you must decide to either buy a health insurance policy with sub-limits or without sub-limits as per your budget and health coverage needs.

    Types of Sub-limits in Health Insurance

    Most health insurance providers place two kinds of sub-limits on a health insurance policy i.e. on the hospital room rent and the sum insured for specific diseases. Some companies also provide the policyholder with the option to opt for or opt out of sub-limits.

    Let’s understand the two key types of sub-limits in health insurance so that you can make an informed decision:

    1. Sub-limit on Room Rent

    Under the room rent sub-limit option, your health insurance company covers the hospital room rent per day but only up to a certain limit. If you opt for a room with a daily rent of more than your sub-limit, then you will have to pay the additional charges.

    For example, If the room rent cap in your health insurance plan is Rs 4000 per day and you opt for a room that costs Rs 6000 per day, you will have to pay the difference of Rs 2000 from your pocket.

    The type of hospital room can also be capped under this type sub-limit. This happens because the hospitalization charges are also linked with the type of room you opt for. Most of the medical expenses, such as surgical procedures, doctor’s consultation charges, operation theatre fees, etc., may vary depending on the type of hospital room you are staying in.

    For instance, the insurer may include only the general room or twin-sharing room in its insurance plans. If you need a private room, then you may have to pay an extra premium for it. This can happen because a twin-sharing room or a general room may cost less as compared to a private room.

    2. Sub-limit on Specific Treatments

    Under the specific treatment sub-limits, the insurance company places a coverage limit on the total treatment cost of specific diseases. Even though your sum insured may be high, you will not be able to claim your entire hospitalization expenses due to the sub-limit clause on specific medical procedures.

    For instance, suppose your health policy comes with a sub-limit of 50% of the sum insured for cancer treatment. In this case, even if your total sum insured is Rs 10 lakh, you cannot claim more than Rs 5 lakh for cancer treatment due to the sub-limit clause.

    Before you decide to buy a health policy with a sub-limit on the specific treatment, you must check the list of diseases/ailments which come under the sub-limits clause and the coverage limit specified against each of them. It will help you to be aware of the sub-limits under a health plan and make an informed decision about buying it.

    Summing It Up

    Sub-limits are an important feature to keep in mind while buying a health insurance policy. The decision to buy a health plan with sub-limits depends on your preference and budget. If you want to make your hospitalization and claim procedure hassle-free, then it is important to go through the sub-limit clauses under a health plan and opt for it only if it meets your budget and coverage needs.

    Written By: PolicyBazaar - Updated: 16 November 2021
    Search
    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

    Health insurance articles

    Recent Articles
    Popular Articles
    Is Crohn’s Disease Covered by Health Insurance Plans in India?

    14 Jan 2022

    A healthy digestive system is a sign of a healthy person. To keep...
    Read more
    Health Insurance Online v/s Offline: Which is Better?

    04 Jan 2022

    While buying a health insurance policy, you have the option to...
    Read more
    List of Diseases Covered by Max Bupa Health Insurance

    23 Dec 2021

    The COVID-19 pandemic has taught everyone to take their health...
    Read more
     List of Diseases Covered by Aditya Birla Health Insurance

    21 Dec 2021

    We are all surrounded by endless possibilities of contracting a...
    Read more
    Omicron COVID Variant: All You Need to Know

    08 Dec 2021

    The COVID-19 pandemic has been making the world dance to its tunes...
    Read more
    Best Health Insurance Plans in India 2022
    Finding the best health insurance plan from so many different health insurance companies can get confusing for many...
    Read more
    PMJAY Scheme: Ayushman Bharat Yojana Eligibility & Registration Online
    Prime Minister Shri Narendra Modi announced the launch of (PMJAY) Ayushman Bharat Yojana in his Independence...
    Read more
    How Senior Citizens can save Tax with Medical Bills u/s 80 D?
    Senior citizens can save on income tax by availing tax benefits on medical expenses under Section 80D of the Income...
    Read more
    Best Maternity Insurance Plans
    Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood...
    Read more
    Covaxin vs. Covishield vs. Sputnik vs. Pfizer: Which one should you get?
    Covaxin vs. Covishield vs. Sputnik vs. Pfizer, the speculation continues regarding the difference between the...
    Read more
    top
    Close
    Download the Policybazaar app
    to manage all your insurance needs.
    INSTALL