Understanding the terms 'capping' or sub-limits in a health insurance policy is crucial. This clause sets a maximum limit on certain hospital expenses, potentially leaving the policyholder with unexpected additional costs. Let's explore the definition of capping, the expenses it applies to, and the necessary precautions.
What is Capping or Sub-Limit in Health Insurance?
In health insurance, 'capping' or 'sub-limit' refers to the maximum amount an insurance company will pay for a specific medical expense or service. This means that during hospitalization, a pre-defined limit exists for certain expenses such as room rent, ICU charges, or specific medical procedures. If the expense exceeds this limit, the policyholder must bear the additional amount themselves.
Which Expenses Does Capping Apply To?
Capping typically applies to room rent, ICU charges, medical procedures, diagnostic tests, and some surgical expenses during hospitalization. For example, if a policy has a room rent cap of ₹5000 per day and the hospital room rent is ₹8000 per day, the insurance company will only pay ₹5000, and the insured individual will have to pay the remaining ₹3000.
Terms and Precautions Related to Capping
Some health insurance policies also impose separate capping on expenses for specific diseases or surgeries. Additionally, there might be a limit of 2-4% on ICU room charges depending on the policy. Therefore, it's essential to carefully read these terms before purchasing a policy to avoid unexpected expenses during claims.
Policy Alternatives Without Capping
The market offers policies with no capping on room rent. However, the premium for such options is usually higher than standard policies. If budget allows, this option provides better coverage, especially for those seeking high-quality hospital facilities.
Why is Information on Capping Important?
Lack of awareness about capping can lead to policyholders having to pay a portion of the hospital bill themselves, increasing their financial burden. Therefore, when purchasing a policy, it's crucial to ensure that the capping limit is suitable for your needs and that the policy terms are clear.
