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Room Rent Limit - How it impacts your claim?

Neha Gadoo Neha Gadoo 27 January 2017

Room rent in health insurance plan is a critical factor, which decides the premium amount of the plan and claim settlement amount. Read about room rent before you buy a health plan.

Health Insurance Claim

Luxury has a price. Health Insurance is no exception to this.

Room rent limit - a very tiny clause, buried deep in the reams of text in your health insurance policy, is one of those clauses which can end up becoming a major pain for you.

Most companies/agents fail to explain this clause, even if they disclose it. Why? Because it's slightly difficult to understand, the words used to describe it are very misleading and of course ignorance is bliss. The more ignorant you are, the more blissful is the sales guy.

So let's dive into this dangerous world of terms and conditions in your insurance policy and try and disarm this killer clause called ROOM RENT LIMIT

What is this ROOM RENT LIMIT?

Your health insurance policy sets the maximum per day room charges that you are eligible for in case you get admitted to a hospital. It works the same way as how a Vice-President in a company is allowed to check into a 5-Star hotel, whereas the Manager can only check into a 3 Star hotel. In this case, the company decides the per day room charges.

Ok Great, so where is the problem?

The problem starts when you realise that the same hospital will charge richer people more for the same treatment. Yes. You read it right. The numbers below are just to make it easier to understand. This is not necessarily what an ANGIOPLASTY (Angioplasty is a non-surgical procedure that can be used to open blocked heart arteries) will cost, its illustrative.

Health Insurance Hospitals

That's not all. All other expenses incurred during your hospital stay are also charged as per the room type. Stuff like admission charges, changing of drips, routine analysis etc.etc. will also be charged as per room type.

Didn't think that was the case, did you? But we have done the research and this is the reality of how hospitals charge patients. You now know, where we are going with this. But let's simplify it further.

Let's say you have this 'Supercool Health Insurance' from ' The Classy Insurance Company' and you're feeling you got your bases covered. So this policy has a Sum Assured or Coverage Amount or Sum Insured of Rs. 3 Lacs and room rent limit of Rs.2,000 /- per day.

Health Insurance Companies

So irrespective of your Sum assured or Coverage Amount of Rs. 3 Lacs, Classy Insurance Company pays as per the room you were eligible for under your policy. Your room rent limit was Rs. 2,000 and only the General Room category was under that limit, so that's all you can claim. Classy Insurance Company, not so classy anymore, eh?

So bottom line is, you don't just fork out the difference in the cost of the room, but you pay the difference on the entire stay in the hospital and treatment cost because as you now know, the charges are all sort of tied up with the kind of room you are renting. So, what's the way out of this?

No Limit on room rent or policies with high limits are easily available. Are they expensive ? A little bit - but totally worth it, if you are picky about the hospital, the amenities, the quality and the privacy ! Quick tip: Room rent limits are expressed as flat Rs 3,000 per day or as a percentage of your Sum Assured. Let's say 1% of sum assured which is 3 lacs. In this case too, it works out to Rs.3,000 per day - means the same thing. Don't get jargon-ized.

Wanna know why Classy INSURANCE COMPANY complicates this so much?

Simply put, it's economics. The rich are supposed to pay more. If you are able to afford a higher category room, you can also afford to pay a higher premium and buy a policy which does not have such a restriction. Also if one has paid a lesser premium, he should not end up utilizing premium services. Such a limit is also a measure to curb abuse of insurance policies, so that people who buy lower sum insured do not end up claiming the entire amount in trivial treatments in luxury hospitals. So it's kinda fair, but you need to be clear on what you have bought and what it covers before you choose a room at the hospital and assume all will be taken care of.

Recommended Read:Room Rent Limit in Health Insurance.

Neha Gadoo
Written by Neha Gadoo
Daring and Bold, Neha loves philosophy, trekking and walking bare feet in the rain. Loves talking and can stare out of a car window for hours continuously.