Check for restrictions on room & room rent
Imagine falling sick and finding out your insurer has a limit on room rent. You pick up the policy document begrudgingly and notice that that cap is set at 1% of your sum insured. 1% of ₹5 lakh insured is ₹5,000 each day. That’s not a lot. And now you are upset you can’t pick the room you wanted — one that costs ₹10,000 a day.
But you’re fairly certain you won’t be staying here for long. It’s only going to be for a couple of days. And even if you pick the nicer room, you’ll only have to pay the extra ₹10,000 (2 days*5000). So you choose the plush room anyway. However, 2 days later, you’re discharged and the insurance company drops a bombshell.
You’ll have to pay an extra ₹25,000. What?
Well, their carefully worded policy document notes that most services rendered in your room including surgeon fee, consultant fee, other diagnostic exams, etc will not be covered fully. Instead, they'll only pay a part of it because you picked a room that's too expensive.
How much will they pay? Well, here's the math. The cap on room rent was fixed at ₹5,000, remember? Your actual room rent stood at ₹10,000. So they'll cover half your room rent and half the cost of all the services rendered in your room. For instance, if you have to undergo an operation and the surgeon's fee adds up to ₹50,000. They'll only pay ₹25,000. The rest is on you.