Top 5 FAQs about Sub-limits under the Health Insurance Policy


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Updated on Aug 31, 2023

Buying a health insurance policy is one of the wisest things that you can do for yourself and your family. It will not only help in saving you a lot of money but also helps in getting the right treatment from the best hospital in your city. However, when you buy a health insurance policy, you need to know about many things. One of the most important things is the sub-limit in health insurance. So, let us discuss the sub-limit under health insurance today.

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5 FAQs about Sub-limits under the Health Insurance Policy

1. What is a Sub-limit in Health Insurance?

The meaning of a sub-limit in health insurance is a pre-determined capping that is applied by the insurance companies on a few of the medical expenses under a health insurance policy. It can be called a limit of the claim amount that the insurance company will pay for a healthcare expense. Sub-limits are applicable in reimbursement as well as cashless settlement.

2. What are the Types of Sub-limits under Health Insurance?

There are majorly two types of sub-limits in health insurance, which include:

  • Sub-limits on particular diseases: If you plan to buy a health insurance policy these days, you will find insurance companies offering insurance products for various types of illnesses, to people and families. There are sub-limits on the diseases that can be covered under a health insurance policy.  Even if the sum insured is high, the entire hospitalization expenses cannot be claimed because of the sub-limit clause on some of the medical illnesses and procedures.  Therefore, while buying a health insurance policy with a sub-limit, you must find out all additional information related to the illnesses that fall under the sub-limits clause. You should also try to know the coverage limit for particular illnesses. This will help you to decide while buying a health insurance policy.
  • Sub-limits on room-rent: Under this option, the insurance provider covers the hospital rent on a per-day basis but to a certain limit. On choosing a room on a per-day basis and if the rent is more than the sub-limit, the additional charges have to be paid by the insured. The type of hospital room you are taking on rent is also capped under this sub-limit. For example, if only twin-sharing or a general room has been mentioned by the insurance provider, and if you take a private room, you have to pay an extra premium.

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3. What are the benefits of sub-limits in health insurance?

Sub-limits are usually restricted to room rents and certain specified illnesses. Nevertheless, you may come across some insurance companies that may let you customize the sub-limits as per your convenience. You need to know that the health insurance policies that do not come with sub-limits have premiums higher compared to the health plans that have sub-limits. Therefore, before you purchase a health insurance policy, you must assess your needs as well as your budget.

4. Do all insurance plans come with sub-limits?

Sub-limits are applied on only some insurance plans and not all of them. Some insurance providers apply sub-limits only on certain illnesses and room rents, in most cases. You may even find an insurance provider that will let you reject the clause.

5. How do you find out if sub-limits are included in health insurance plans?

The foremost thing that you need to do is to visit the website of the health insurance company and understand the meaning of sub-limits in detail. You can also find out from the website if they apply sub-limits on some health plans. Another thing that you can do is to check the policy documents such as terms and conditions and prospectus to understand the sub-limits that are applied under the health insurance policy that you intend to buy.

To conclude, we can say that understanding and finding all kinds of details about health insurance plans and the sub-limits applied to them is very important before you make a decision. This will help you to stay away from any kind of surprises while claiming the sum insured.

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Aug 28, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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