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Question regarding the Room Rent Cap

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13 Sep, 2021 by  Jay

Recently I have taken the 1Cr policy which is of 5L(Base) + 95L(Super Top Up). In the policy wordings, it is mentioned that the Room Rent Cap is up to the Sum Insured(5L). Is that mean, a dedicated 5L amount will be allocated to the Room Rent Charges for the given year? Or does it mean, if the base limit is exhausted in first claim, I'm not eligible to receive any more amount Under Room cap? Assume we don't have any restoration benefit.


For example, I have taken the claim of 5L in the first hospitalization, for that it took 1L for Room Rent and 4L for treatment. In the second claim, will I eligible for receive Room Rent charges under remaining 4L or no honor takes place as I already exhausted base limit.



Also, please clarify what are the benefits we get for higher Base Plan than higher Super Top Plan. Why we should consider the restoration benefit or No Claim Bonus, as we already getting high Sum through the Super Top Up? What are the jargons which make Base Plan with NCB/Restoration highly important.


If we have taken 5L and want to upgrade to 10L/20L next year, will I loose one year benefits? Please try to answer all of questions? Thanks in advance.

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15 Sep, 2021
Jay

Anyone there to reply, please?

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16 Sep, 2021
harivansh agrawal

I think if It says the room rent limit is only on the base sum insured Not up to as generally most of the top-up does not have the room rent limit so you can opt for any room(i.e at actuals )after the threshold or deductible limit is crossed

if you can specify the base plan and super top plan combination I will try to tell you more


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16 Sep, 2021

Hi Jay ,


I’ll try to explain you.


You have taken 1 CR Sum Insured (SI)— 5 Lakhs ( Base SI) and 95 Lacs ( Super Top Up SI )


There can be two types of policies -

a. One master policy with both base and super top up

b. Two different policies — One for Base policy and another for Super top Up


Two different policies are more common. I’m assuming that you have two different insurance policies ( May be from same company ).


Now, when you have two different policies both will have different policy wording. And both the policy wording states that room rent is capped up to Sum Insured.



And if we assume that you have One master policy then your SI is 1Cr and your room rent limit is maximum up to 1 Cr.



This implies that you can claim maximum room rent up to 1 Cr in either ways

Hypothetically, you have made a claim and there is only one element in the claim that is room rent then you can claim maximum 5 lakhs of room rent from base policy and maximum 95 lakhs from Super top up.

However, Super top up claim can only be made if and only if you have exhausted deductible of 5 lakhs.


In theory , there is no difference between Super Top up + Base policy or base policy of 1 cr if all the policies have started on the same dates and same policy wording


However, In insurance industry , Super top up policy may have different policy wording and Base policy may have different policy wording.


Regards

Nimesh


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17 Sep, 2021

Dear Jay

There is only one difference difference in base and STU .

STU begins only after you have used Rs 5 lakh .

For ex

You do not have any base plan and have only a STU of 95 lakh with 5 lalh deductible. Let us say ypur hospital bill is rs 15 lakh then you will be paid only rs 10 lakh . So it is not necessary to have a base plan , yyou can only have a STU . All features will remain same . Price is less because the probability of treatment exceeding Rs 5 lakh is less . Even base plan pricing is also done in same way and incremental sum assured price is proportionately lesser .

Now your answers :

1. As you have slready exhausted rs 5 lakh hence you are not entitled .

2. There is no difference between high sum assured and STU . It just increases your paper work because hospital would entertain STU only after exhaustion of base and may demand cash till your STU is approved . Please note patient is already under treatment . So it offers convenience .

3. You will enjoy continuity for previous sum assured but not for increased amount . This means continuity is for Rs 5 lakh .


Hope this clarifies


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17 Sep, 2021
Jay
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