The Truth About The Room Rent Limit In Your Health Insurance

Considering the growing awareness of health insurance, people are looking to choose a health plan with adequate cover to easily pay off the medical bills. You need to consider various parameters before buying a plan, such as plan benefits, sum insured, type of plan, sub-limit, co-payment, network hospitals, free medical check-up, etc. Health policy has a wide range of coverage, and every coverage has a different impact. Being an insurer company, they always try to provide you with better options and some of the service that is remarkable as an insurance company. This article will discuss the “Room Rent in Health Insurance” and how it would impact your health insurance claim.

Before buying a health policy, we all try to know about every insurance policy and about every insurance company. The reason is, we just want to know the benefit, key points, and coverage of the plan. One thing that is common in every insurance policy is, they all offer us the same health policy but it’s a benefit and the coverage of the plan that create a difference. Talking about coverage of the policy, there is an option of ‘Room Rent.’ During hospitalization, patients need a private room for proper treatment, and insurance companies cover the expenses of the room and it’s known as ‘Room Rent’. 

Room Rent Limit

Room rent is a type of sub-limit clause under which the insurance company covers the hospital room rent daily up to a certain limit; every company offers you room rent. Still, some company offers you ac room and some company offers you sharing room. For instance, if the room rent cap under the plan is Rs 3,500 per day and you opt to accommodate a room that costs Rs 5,000 per day, you will have to pay the difference of Rs 1,500 from your pocket.

A lot of health insurance buyers are comfortable with the room rent limit. Usually, people have a perception that they only have to pay the excess room rent from their pocket. If the excess room rent is Rs 1,500 per day and you stay in the hospital for 6 days, you will have to pay Rs 9,000 on your own.

If you think that it is the only additional cost you need to pay, you are wrong.

Impact on Hospital Charges

In addition to the excess room rent, hospital charges are linked to the type of room you have opted to get hospitalized. If the doctor’s visit to a shared room costs you Rs 1,000, then a visit by the same doctor may be charged at say Rs 2,000 if you opt for a private room. It’s not justified, but that’s the truth.

Hospitals levy charges based on your ability to pay. If you opt for a private room, you are charged higher for the same medical or operational procedure. For instance, if staying in a twin-sharing room, a surgical procedure costs you Rs 20,000. However, the same procedure may cost you around Rs 35,000 to Rs 40,000 if you opt for a private room.

Suppose, you don’t have a health policy, and in this scenario, you have to pay bills on your own. If you never think about taking a room for rent in the hospital or its way necessary, you will try to rent the cheaper one. So, yes, the room rent option impacts the hospital charge, if you are paying the hospital bill. But if your insurance company, paying the hospital bill, then it’s quite the best experience for you, because you are getting the best service with the help policy.

Impact on Insurance Claim

As the charges levied are linked to the type of room you stay in, the medical bill tends to go higher if you opt for a deluxe hospital room. In case your health cover does not have any sub-limits, an insurance company just has to pay for all the covered expenses.

If you have a health cover with the sub-limits, the company will cover the medical expenses proportionate to the rent sub-limit to actual rent.

Suppose the room rent limit in your health plan is Rs 3,500 per day, and the actual room rent is Rs 5,000. You get hospitalized for six days and run up a bill of Rs 1.5 Lacs.

If you think that the insurance company will cover all expenses apart from excess room rent, i.e., Rs 1.5 Lacs – 1500 * 6 days = Rs 1.41 Lacs. That’s not true. The reimbursed amount will be Rs 1.5 Lacs * 3500/5000, which equals Rs 1.05 Lacs.

Even though you had a sum insured of Rs 5 Lacs, you will be reimbursed an amount in proportion to the room rent. The bill amount to be borne by you is Rs 45,000.

Here, you can see the impact of choosing a room rent under the health policy, which can be shocking for those who are unaware of this aspect.

Conclusion

Health insurance plans without sub-limits come with higher premiums than those with them. Opting for room rent sub-limit may help you reduce the cost of health insurance, but at the time paying bills, the insurance company will cover the medical bills only in the proportion of the rent sub-limit and the rest of the amount you need to pay on your own.

Ideally, you should buy a health insurance plan without a room rent sub-limit, as it ensures comprehensive protection against medical expenses. If you cannot afford a plan without a sub-limit, don’t forget to read through its limitations and the extent of coverage available under such plans.