Sub-Limits or Package Treatments in Health Insurance Policy

What Exactly are Packaged Treatments in Health Insurance?

Packaged treatments give you the ease to choose plans that will cater to your particular needs for treating specific ailments or to cater to your family requirements if there are any. You can opt for family floater plans, which will extend coverage to your entire family, usually covering yourself, spouse, dependent children and parents. These packaged plans are especially beneficial when anyone in the family falls sick or meets with an accident as the coverage amount can be used to treat any member of the family. Also, it extends benefits like a network of hospitals that you can visit to avail the services and cashless treatment among other services. Also, many insurance companies have started including packages for treatments, which are chosen on the basis of the selected hospital rooms. The package will include the cost of the treatment along with the room rents and hospitalisation expenses.

What Features Should a Packaged Treatment Plan Consist of?

Besides providing coverage for the ailments, a packaged treatment plan must provide essential coverage for other areas, which form a crucial part of your expenses. Thus before opting for any packages you must ensure that the plan covers pre and post hospitalisation expenses, takes care of your medical expenses and also has a good network of hospitals.

Why is it Important to Read the Fine Print?

Although packaged treatments are meant for your convenience over and above anything else, it is extremely important that you go through all the terms and conditions carefully before signing on the dotted line. Financial advisers stress upon the need to understand and read the fine print for a better understanding of the nitty gritties associated with each plan. The most crucial limitation of these plans is the imposition of a “sub limit”.

Read more about: Health Insurance - Reading the Fine Print

Sub Limits - What are They?

Usually imposed on common ailments like kidney stone, cataract, sinus, piles etc., sub limit is a clause, which many insurance providers employ to restrict their outflow and eventually it eats into your claim. Basically, by using sub limit, a company puts a cap on the amount it will pay for a certain ailment and will not pay beyond the sub limit mentioned. Thus if the procedure costs more than the sub limit specified, you will have to shell out the remaining amount from your own pocket.

For e.g., let us assume Shubham has invested in an insurance plan worth 10 lakh rupees and requires a hernia operation. However, the sub-limit on a hernia procedure is Rs 35,000. Thus, if the hernia operation costs him Rs 1 lakh, he will only receive 35,000 and has to pay the remaining Rs 75,000 from his own pocket. Additionally, sub-limits are not only imposed on procedures but also on hospital room rents.

You may also like to Read: Sub-limits in Health Insurance Policy

Sub Limits on Room Rents

Health insurance companies usually have a cap of 1.5%-1% of the total sum assured on hospital room rents. So if you have an insurance policy worth 3 lakh rupees, you’re per day limit for each day of hospitalisation will be approximately Rs 3,000. If you choose a room that is more expensive than this, you will have to shell out the remaining amount from your pocket.

Concluding

So when you plan to go for a packaged treatment plan, it is crucial to read the terms and clauses carefully, and choose the package that guarantees you the rooms you prefer; otherwise, you may end up paying through your nose!

Health insurance companies

View more insurers

Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

❮ ❯

Health insurance Articles

Recent Article
Popular Articles

07 Feb 2025

Reimbursement Claims in Health Insurance

Health insurance is essential for managing medical expenses, but

05 Feb 2025

Cashless Claims in Health Insurance

Health insurance plays a crucial role in providing financial

21 Jan 2025

Cumulative Bonus in Health Insurance

Health insurance provides a financial shield against planned and

10 Jan 2025

Benefits of Health Insurance

In today's fast-paced world, changing lifestyles have led to a

10 Jan 2025

Human Metapneumovirus (HMPV): All You Need to Know

The world experienced a crisis of a lifetime in 2020, with the

*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

*The values taken for effective cost calculation are indicative values and may change as per the selected plan.

*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

*The scope of coverage may vary from plan to plan.

~Source: Google Review Rating available on:- http://bit.ly/3J20bXZ

##On ground claim assistance is available in 114 cities

Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.

STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.

Policybazaar is a registered Composite Broker |Registration No. 742, Valid till 09/06/2024, License category- Composite Broker| Visitors are hereby informed that their information submitted on the website may be shared with insurers.

Policybazaar Insurance Brokers Private Limited | CIN: U74999HR2014PTC053454 | Registered Office - Plot No.119, Sector - 44, Gurgaon, Haryana - 122001 Contact Us | Legal and Admin Policies

Sub-Limits or Package Treatments in a Health Insurance Policy