Room Rent Capping In Health Insurance

Room rent capping is the limit on the hospital room rent borne by the insurance provider under a health insurance policy. For instance, if the room rent is capped at ₹5,000 by your health insurance provider, the room rent expense of only up to ₹5,000 can be claimed for room rent. The room rent limit can either be an absolute amount or a specific percentage of the policy’s sum insured. 

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Room rent capping is an important element to consider within your health insurance policy. It dictates the limit of your hospital room costs borne by the insurer. The room rent cap could either be a figure stating a certain amount to be covered by the insurer or a percentage of the sum insured.

 

Your health insurance policy will usually explicitly state the room rent capping. For instance, if the room rent is capped at ₹5,000 by your health insurance provider, expenses of only up to ₹5,000 can be claimed for room rent.

When it comes to hospital room rent capping, there are numerous types and maybe different for each health insurance company. So, it is recommended to always read the fine print and make an informed decision when it comes to the hospital room rent. Here are common types that you should look out for:

• No Capping on Room Rent

The no room rent capping, meaning in health insurance, is zero limits on the hospital room rent. Hence, you can choose the room type as per your needs during hospitalisation.

• Room Rent Capping

Here, the insurance provider puts a limit on the hospital room rent, and thus, you cannot claim any expenses higher than the specified amount.

• Copayment on Room Rent

For copayment on room rent, the expenses incurred for the hospital room shall be shared between you and the insurance provider.

• Room Rent on Certain Room Types

During hospitalisation, you shall be given the option to choose a hospital room type based on availability. If your policy has a cap on certain room types, then you may pick a room based on the limit mentioned in your plan or bear the extra expenses.

• Room Rent Waiver Add-On Cover

You can opt for the room rent waiver add-on cover with your health plan to waive off the specified limit.

You can understand the average hospital room rent in India, including the cost of ICUs. However, you must know that these rates vary from one hospital to another and depend on the city as well.

How No Room Rent Capping Feature Affects Your Hospital Bill

The below table illustrates how the no room rent capping feature can affect your hospital bill:

The above table explains how going for a healthcare plan with no room rent capping can affect your claim settlement amount. Hence, if you want maximum coverage during medical emergencies, it is best to go for policies without any room rent capping.

As we have already looked at the room rent capping meaning, let’s understand the perks of having a health plan without any room rent capping.

• Zero Restrictions on Hospital Rooms

Due to no room rent capping applicable under your insurance plan, you can easily opt for a hospital room of your choice. Furthermore, you can pick a room type based on your requirements without worrying about the insurance coverage.

• Enjoy Maximum Benefits

Without any room rent capping, you can enjoy maximum benefits under your insurance policy. The no room rent capping feature lowers the out-of-pocket expenses that you would have to bear in case you exceeded the room rent limit.

• Comfortable Stay

You can have a comfortable stay while you are recovering and put your needs first during hospitalisation. 

There are two scenarios concerning your health insurance policy: 

• You are Already Covered Under a Policy With Room Rent Capping

In case you relate to this scenario, you must consider switching to a different insurance provider or changing your insurance plan at the least. To do this, you must port the current plan to one that doesn't have any capping on the room rent. If you do not want to go through the hassle of switching plans, you can also upgrade the sum insured. This shall increase the room rent limit and allow you to choose a room of your preference. 

• You are Looking for a New Health Insurance Policy

If you are someone who is still looking for a new health insurance plan, go through all the documents related to the policy you wish to buy. This will give you some clarity on room rent capping. In case there is no information about it, you can connect with your insurance provider and ask if your plan has this clause.  

Here are a few tips with respect to room rent capping that you must employ while health insurance:

• Understand the different terms and conditions associated with room rent capping in health insurance.

• Read the fine print carefully during the free-look period in health insurance.

• Verify the room rent clause with the insurance provider if you do not have the policy document.

• Compare health insurance plans online while considering these factors.

• Identify the policies which are lenient in room rent capping and then make an informed decision.

It is important to consider room rent capping while selecting a suitable insurance policy for you and your family. This limit determines the amount your insurer shall pay out during settlement and also decides the room type you can get during hospitalisation. And now that you have understood what no room rent capping means in health insurance along with its benefits, the next step is to opt for the right coverage! Without health insurance, you will have to bear the financial burden of soaring medical expenses and various ailments linked with your fast-paced lifestyle.

 

If you want to opt for a plan with extensive coverage, head over to Bajaj Markets, where you can benefit froml health insurance policies with no capping on room rent. Enjoy a cashless health insurance facility, speedy renewals, cumulative bonus, and more with us!

Health Insurance Plans Available at Bajaj Markets