Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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Capping and Sub Limits in Health Insurance

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Capping or sub-limit is the maximum amount one can avail under a specific heads covered in the Health Insurance plan. The structure of sublimit is within the total sum assured. If the expenditure is more than the specified limit, it is to be borne by the insured. Most health insurance companies have these sub limits specified in the Policy document. On one hand they allow availability of more funds for other medical procedures, they limit it for the ones that are capped.

Some of the expenses that are capped

Room Rent – Room rent is the first thing that is capped. Generally it is kept to 1% of the sum Assured per day. It may also be a fixed amount mentioned in the policy schedule. There are certain companies that do not cap room rent.

ICU Charges – Many insurance companies put the capping to ICU charges at about 2% of the Sum Assured per day or even a fixed amount may be mentioned.

Ambulance Charges – Capping of ambulance charges may vary from company to company. Some insurance companies cap ambulance charges for a specific amount per Hospitalization up to a fixed number of visits. Here the cap is on number of visits as well as amount per visit. Some companies limit the annual amount that can be availed as ambulance charges during the year. There is no limit to the number of hospitalizations in this case but a capping on the maximum amount that can be availed as ambulance charges.

Maternity Charges – Generally, maternity is not covered under health insurance. If at all it is covered under the policy, it has a Waiting Period of three years or more. A fixed amount is allotted for the purpose depending upon the type of policy. Any expenditure over it is to be borne by the insured.

Daily Cash (for accompanying Insured child) – Health insurance policies also have the facility of daily cash for the person accompanying an insured child. The maximum limit of the daily cash is also mentioned in the policy documents.

Sub-limits and caps put on different aspects of health insurance depend upon the insurance company, type of policy and the sum assured. Just as it is important to decide the sum assured you need, it is also important to know these sub-limits to make sure they correspond to the rents and charges of the hospitals you visit. We suggest that you compare these sub-limits along with other features before you buy.