Hidden ‘room rent’ clause in health insurance can cost you thousands | Expert explains

Samay went to the hospital believing his ₹10 lakh health insurance policy would fully cover his treatment. But when he walked out with a ₹5 lakh bill, the insurance company asked him to pay almost half of it himself. Shocked and feeling cheated, Samay sought an explanation. The insurer clarified total miscalculation occured as he opted for a room that was beyond the room rent limit specified in his policy. Here's a look at what is room rent limit, and how a hidden clause under can kill your health insurance claim?

What is room rent clause in health insurance?

The room rent clause is a condition in your health insurance policy that defines which room category you are eligible for during hospitalization. Modern plans categorize this as:

● General Ward - multiple beds, shared space

● Shared Room - 2–3 beds, semi-private

● Single Private AC Room - private, air-conditioned

● Any Category - no restriction, any room in the hospital

How a minor upgradation can impact your health insurance claim?

Answeing this, Siddharth Singhal, Head of Health Insurance at Policybazaar, explains It's the maximum room category your insurer will cover. If your policy says "Single Private AC Room," that is your entitlement. You can choose that room or anything below it - fully covered.

“The moment you pick a room above your eligible category (say, a Suite or Deluxe Room), the insurer pays only up to the Single Private AC Room rate, and you pay the difference from your own pocket,” he further notes

The impact is straightforward:

For example, suppose your health insurance policy covers a single private AC room at ₹6,000/day, but instead of opting for that when you get admitted to the hospital, you choose to stay in a suite at ₹15,000/day. Now, you will have have to pay for the difference, i. e. ₹9.000 in this case.

Hospitals in India bundle many costs with the room category. So this, this minor room upgrade can result in thousands in deductions for related, non-room expenses like nursing or surgeon fees

How can you avoid falling into the room rent trap when buying a health insurance policy?

Sharma advises, “Choose a plan with no room rent capping at all - these plans cover any room category without proportional cuts. Always check the ICU cap separately, read the proportional deduction clause in the fine print,”

And, most importantly, at the time of hospitalisation, ask the hospital for a room that falls within your policy's permitted limit, Sharma concludes