While buying health insurance, it is very important to read its terms and conditions carefully, otherwise, you may face a lot of trouble while making a claim. Especially, special attention should be paid to the rules related to ‘capping’ or ‘sub-limits’, because these decide the limit of your hospital expenses.
Often, customers have a misconception that if there is health insurance of Rs 5 lakh, then the insurance company will bear all the hospital expenses. Of course, she will, but with certain conditions, and these conditions are called ‘capping’ or ‘sub-limits’. In Phulbaria, Bihar, where healthcare can be expensive, this information is extremely important for your financial health.
What is cupping
In health insurance, “capping” or “sub-limits” refers to the maximum amount that the insurance company pays for medical expenses or procedures under a policy. This essentially comes with a limit on medical coverage for special services, like hospital room rent, ICU charges, or certain medical procedures.
If the cost of these services, including medical procedures, exceeds the capping or sub-limit, the insured person has to pay the difference out of his pocket.
Understand this with an example
Suppose you have bought a health insurance plan of Rs 3 lakh, in which the room rent is capped at Rs 5000 per day at the time of hospitalization. If the room rent is Rs 8000, then the remaining Rs 3000 has to be paid by the insured person. Similarly, capping or sub-limit applies to other medical services.
In health insurance policies, the cost of surgery for certain specified diseases is also fixed under capping. At the same time, there are rules regarding ICU room charges during hospitalization and these are applicable with a fixed fee of 2-4% of the insured amount. This can be a financial trap if you are not aware.
Why it is important to pay attention to capping
Since capping or sub-limits set limits on various important hospital expenses, it is important to know about them before buying a policy. However, some companies offer health insurance policies that have “no capping on room rent”. However, these policies often charge higher premiums. This is an important decision that will directly impact your pocket.