Three reasons why you don't get 100% health insurance claim

We often hear people complaining about their health insurance policies. One of the common contentions is the fact that insurance company deducts a large sum while reimbursing hospital bills. What are these costs? Why do insurance companies deduct them at the time of claim settlement? Well, at the time of buying a health insurance policy you should clearly ask your agent about items that won’t be paid by your insurer.

To guide you through the maze here are three reasons that can cost you dearly at the time of a claim settlement process.

Co-payment Clause  

Copayment is the percentage of hospital bill which the insured has to pay from their own pocket in the event of a claim. But most of the times, in a hurry to sign the dotted bills, one doesn’t read the policy documents properly and gets surprised when asked to share the bill which could be as high as 20%.

Sub-limit Clause 

Always watch out for sub-limits, as it means that your insurer specifies a limit for an expense and anything above that needs to be borne by you, room rent, diagnostics, and doctor’s fees are the most commonly sub-limits in your health insurance policy. You need to check the limits while choosing a policy. For example, assume you have a policy with a cover of Rs 5 lakh and a room rent sub-limit is 1% of the sum insured. Then in case of hospitalisation, your insurer will pay you only up to the limit of Rs 5,000 for room rent.  Suppose you take a costlier room at Rs 7000 then your insurer will reimburse you only Rs 5,000 and the remaining amount of Rs 2,000 will be borne by you.

So, the actual deduction works out to be much higher than what you expect from your policy at the time of claim settlement. Clear understanding at the beginning can rid you of heartburns at the time of claim settlement.