Concept Of Room Rent Limit In Health Insurance Policy

Mr. Aditya purchased a health insurance policy of Rs. 5 lakhs that has a room rent cap of 1% of the sum insured. After a few years, Aditya was hospitalized for hip surgery. He stayed 5 days in the hospital where he selected a private room for himself. As per his insurance policy, he was eligible for a room that cost Rs. 5,000 per day. But he selected a hospital room that charged Rs. 8,000 as one-day room rent. His insurance company paid only Rs. 5,000 per day, and Aditya paid the remaining difference of Rs. 3,000 per day for 5 days.

When a person purchases a health insurance policy, all of his healthcare bills are settled by the insurer.  Here we will discuss what hospital room charges per day are and how room rent is calculated in the health insurance claim.

What is Room Rent?

Room rent capping in health insurance is the limit up to which your insurer will bear the cost of the room for rent one day once you are hospitalized. If you select a hospital room that costs above your health insurance cap, you need to bear the additional charges from your pocket during the time of claim settlement.

All insurance companies mention hospital room rent caps in their health insurance policy documents so that you don’t face any hassle in your claim settlement process. The room rent cap can be a specific amount, for example, Rs. 15000, or in percentage, i.e., 3% of the sum insured. There is no sub-limit in Star health insurance room rent limit.

The Manipal hospital room charges are Rs. 8000 per day in a city like Bangalore.

Types of Room Rent Limit In Health Insurance Coverage

Various health insurance companies set their own rules when it comes to room rent and capping. But most health insurance companies clearly mention the rules in the policy documents so that the customers don’t face any difficulty at the time of the claim. As a policyholder, you should wisely choose your policy with a specific type of room rent.

Let’s take a look at the common types of room rent capping in health insurance.

1. No Capping on Room Rent: Many health insurance companies don’t offer any cap on room rent in their policy plans. The policyholders can select any type of room as per their wish, healthcare requirements, and comfort.
2. Co-Payment on Room Rent: Co-payment refers to a certain amount that a policyholder needs to bear from his side while staying in the hospital. Co-payment or copay on room rent implies you as a policyholder will pay the costs of room rent and other expenses together with your insurance company.
3. Room Rent with Capping:  Very often insurance providers set a cap on the room rent amount. Beyond this limit, the insurer will not bear your expenses. The policyholder needs to pay the additional expenses from his pocket.
4. Room Rent Cap on Specific Room Types: The policyholder is offered a choice to select a hospital room type as per accessibility and requirement. If your policy permits you a cap on a certain room type then you have two options. Either, you select a room that fits inside the room rent cap of your policy or you can pay the additional expenses from your side by opting for a room that costs more than the limit.
5. Room Rent Waiver Add-on: As the name suggests, you can purchase this room rent waiver add-on along with a health insurance policy that has room rent capping. But the limit will be laid off under this add-on.

How Room Rent Limit Affects Your Overall Health Insurance Claim?

While processing your claim amount, the insurance provider will consider the room rent and applicable capping as the prime component. The claim amount will enhance or decrease based on the room you stayed in the hospital was under or over the room rent cap.

The Solution to Room Rent Capping

There can be two situations in health insurance that will solve your room rent capping problem.

• You are already covered under a policy with room rent capping: Under this scenario, you can alter your health insurance plan or migrate to a different health insurer whichever is possible. You can port your current plan to a new plan that doesn’t have any room rent capping. If you don’t want to discontinue your current plan, then upgrade the sum insured of your policy. This will enhance the limit of your room rent capping. Now, you can select a room for rent for 1 day or for the number of days required for treatment without affecting the claim amount.
• You are looking for a new health insurance policy: Before making any commitment, check all the documents of your plan so that you can clearly understand the room rent capping. If you don’t find any such clause in your policy documents, contact your insurance provider as soon as possible. Ask directly your health insurer regarding this clause.

The Conclusion

Though most health insurance companies usually mention all the clauses including the room rent capping in their policy documents, still, policyholders should avoid partial settlement of the claim. So, before investing your penny in a policy, stock to room rent sub-limits and purchase a policy that comes with no room rent capping.