Sub Limit In Health Insurance

Case Study

Mr. Khanna and his family had just saved enough for a long-awaited foreign trip. However, a month prior to their trip, his daughter suffered from severe stomach pain and had to be admitted to the hospital. She was diagnosed with gall bladder stone and was required to spend a week in the hospital for treatment.

Mr. Khanna’s daughter’s condition improved and she was discharged. He paid the hospital bills from his pocket. He had a family health cover for ` 6 lakhs, under a reimbursement plan. So he duly completed all the required documents and submitted it along with the hospital bills, which included room rent, doctors’ consultation charges, etc. and made a claim for reimbursement.

A few days later, he was surprised to receive a claim approval notice with approval for an amount less than what he had claimed. He was sure that he had completed the necessary paperwork and that the bill amount was less than the eligible amount under the policy. He wondered what had gone wrong and approached his insurance provider. They explained to him that owing to the sublimits he had opted for under the policy, there was a cap on the amount he was eligible to be reimbursed for hospitalisation, doctor’s fees, etc.

Mr. Khanna had to bear a large portion of the expenses and had to cancel the family trip due to his oversight.