Health Insurance

Understand Sub-Limit in Your Health Insurance Plan

When purchasing health insurance, specific considerations should be made to obtain the best coverage possible. Sub-limit is one of the crucial, yet most underappreciated, components of a health…

When purchasing health insurance, specific considerations should be made to obtain the best coverage possible. Sub-limit is one of the crucial, yet most underappreciated, components of a health insurance policy that you need to consider. When purchasing a health insurance policy, the sub-limit must be considered. Sub-limits refers to the cap placed by the health insurance company for expenses. It simply means that the expense to a particular treatment cannot go beyond the sub-limit.

One of the main reasons health insurance companies include sub-limits clauses in their policies is to reduce their overall claims expenditure or to reduce their customers' financial obligations. Insurance companies estimate costs or calculate costs under various headings (room rents and treatment costs) based on the going rates charged by the majority of hospitals to prevent fraud and lessen unjustified inflated medical bills from patients.

Room rental, Ambulance, and Medical Sub Limit

There may be sub-limits in health insurance policies for costs such as lodging, doctor visits, ICU stays, oxygen supplies, ambulance services, and diagnostic tests. A sub limit of 1% to 2% of the insured amount or a set amount of money is typically imposed by insurers on these kinds of costs. Most of the time, this may result in the policyholder paying a sizable sum from the claim. The terms and conditions of the insurance policy mention each of these sub-limits. The best health insurance plans ensure that their clients are fully protected against these costs.

The treatment, necessary medical equipment, and other factors all affect the room rent. These might account for a sizeable portion of the final bill. Before purchasing the best health insurance plan, it is wise to consider how a sub-limit clause might impact these expenses.

How Do Sub-Limits Affect Your Claims

Let us discuss the affects of sub-limits on health insurance claims:

  • As was already mentioned, a sub-limit lowers the total claim amount. You can only file a claim for the amount specified by the sub-limit clause for expenses like hospital room rent, the treatment of specific diseases, or post-hospitalization costs; anything above that must be paid for out of pocket.
  • Due to these sub-limit clauses, even if your sum insured is high, you might not be able to claim for all of your hospitalisation or treatment costs.
  • In order to avoid any last-minute confusion during the trying time of hospitalisation or while making a claim, keep in mind to carefully read these sub-limit clauses. By doing this, you can guarantee a simple claims process.

Are Sub-Limits Mandatory?

While you can look around for policies without sub-limits, their premiums are frequently higher. If you select a policy with these clauses, you won't be able to modify the amounts because sub-limits are determined by the insurance company.

Therefore, carefully read the policy documents' sub-limits and look over other crucial elements like inclusions, exclusions, deductibles, and co-payments before you purchase a policy. You can choose a different insurer or increase your sum insured if you believe the policy's coverage is insufficient to meet your unique needs or medical expenses.


Q. Does every health insurance policy have a sub-limit?
A. No, a sub-limit clause is not a feature of every health insurance policy. Certain conditions or treatments may be subject to sub-limits from some insurance companies.

Q. How to check sub-limits in your health insurance?
A. Simply read the terms and conditions listed on the policy document to determine a health insurance policy's sub-limit.

Last updated on