When a patient is admitted to a hospital to receive treatment, the patient must pay the bill. The hospital bill comprises services that are offered during the stay and treatment.
If you are looking at the bill, you will notice that there are many things on the bill, and one of them is the cost of a room.
If Health Insurance covers a person, the bill is paid by the insurer, and the method by which room rent is figured in the claim could be a challenge for some of us.
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What is Room Rent in Health Insurance?
When someone is admitted to a hospital, the patient must pay daily rent or daily room costs to stay in an area or bed at the hospital.
al. The term “room rent” in insurance covers the boarding fees or per day room expenses that the policyholder might be required to pay while in a hospital.
The room rent limit can be expressed as an absolute amount or as a fixed percentage of the sum insured.
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In other words, the room rent limit in a medical insurance policy is the maximum amount of per day room charges a policyholder can claim when they get admitted to a hospital.
Any amount above this limit will have to be borne by the policyholder.
For example, if your health insurance room rent limit is ₹ 4,000, the maximum room rent you can claim under the policy is ₹ 4,000. If the limit is expressed as “1% of the Sum Insured”, and you have chosen ₹ 5 lakhs as the sum insured, your room rent limit will be ₹ 5,000.
Impact on Claim
If a policyholder’s limit for room rental is 3,000 per day, they are admitted to a room that costs the equivalent of Rs. 6000 per day.
The insurance policy would only cover 50% of the claim amount in this scenario. Insurance companies are in their right to decrease the amount due by the basis of a “pro-rata” basis.
What is Room Rent Capping
Capping refers to the limit.
When we talk about the room rent capping in health insurance, it’s the amount the insurance company will pay for the room.
If you can remain in a hospital room costing more than the capping, you’ll be required to pay the extra amount during the settlement of your claim.
Difference type of Room Rent Limit In Health Insurance
Each health insurer has different rules regarding room rental and caps. All regulations applicable to the health insurance policy are clearly stated in the policy’s document. Here are the typical types of capping room rent to assist you:
No Cap on Room Rent :—
Many health insurance policies do not limit the rent of a room. Policyholders are free to choose the room type according to their needs and comfort—one of the best options for policyholders.
Co-payment on Room Rent :—
Co-payment involves paying a portion of the bill during your hospital stay. Co-payment, also known as co-pay on room rent, implies that the policyholder will be responsible for the rent and associated costs with the insurer.
Room Rent with Capping :—
Insurance companies often limit the sum of room rent that a policyholder can claim. Above the limit, the insurance company won’t be liable for the associated costs.
Room Rent Capping on Specific Room type :—
The policyholder can choose the hospital room type under the availability and needs. When your policy for health insurance permits an upper limit on a particular room type, you have two choices.
You can either choose an option within the room rent limit or pay the extra costs by selecting a room that exceeds the maximum room rent.
Room Rent Waiver Add-on cover :—
As the name suggests, the Room Rent Waiver add-on can be bought with an insurance policy that has room rent capping. But the limit will be waived off under this add-on.
How does Room Rent Limit Affect Your Overall Health Insurance Claim?
When calculating the claim amount, the insurance provider will consider the room’s rent and the applicable caps as the primary element when computing the claim amount.
The claim amount will raise or decrease based on your choice to stay in a space that was not within or over the cap on room rent.
Let’s consider how room rental caps affect your total claim amount by using an example:
If you purchase the health insurance plan, the Sum Insured amount of 5 lakhs, and the room rent is one percent of the Sum Insured. That means the maximum room rent for your policy will be 5000.
If you become admitted to the hospital and select a room less than Rs 5,000 per day, you’ll be eligible to claim hospitalization expenses without deductions.
That means that you will incur 4 lakhs of rupees in hospitalization, and you’ll receive the whole 4 lakhs amount from the insurance company after submitting a claim.
However, if you opt for the room rented for greater than Rs 5000 per day, the claim will be taken in the same proportion as the rent for the room exceeds the maximum room rent amount stipulated in the policy.
That means that if the room’s rent is 7,000 and you claim only 5000/7000, i.e., only 72 percent of the total cost incurred in hospitalization.
That means that if you have to pay Rs 4 lakhs for hospitalization, you’ll get the claim of 2.88 lakhs (4,00,000 X 0.67) through the insurance company.
The Solution to Room Rent Capping
Two scenarios are connected to the health insurance plan:
You’re already covered by a plan that limits Room Rent –
In this case, you may want to consider switching your health insurance policy to a different insurance company altogether.
It is possible to transfer the existing policy to one that doesn’t have a room rent cap. If you’d like to stay using the current plan, consider boosting the covered amount under your health insurance plan.
This will raise the amount for the capping of room rents and let you select a room to your preference without affecting the amount of your claim.
You’re searching for an insurance policy new to you –
You’re searching for an insurance policy new to you: Be sure to go through all related documents to your plan to find more information about the room rent cap.
If you can’t find this information in any documents, we advise you to contact the insurance company and inquire whether their plan includes this clause.
It is not common knowledge that room rent is a concept. Policyholders feel like they are being cheated when they receive low claims amounts.
You need to read the policy document, fine print, and terms and conditions.