My company insurance has a room rent ceiling, but my private insurance does not. How does this affect my claim if I stay in a higher category room?
– Name hidden on request
If a policy has a room rental limit, this may result in proportionate deductions, which can significantly reduce your insurance reimbursement amount. Business insurance policies often include room rental limits, specifying the maximum daily costs for hospital stays. For example, if the cap is ₹5,000 per day and you choose a room rate ₹8,000, you will have to pay the difference out of your own pocket. The impact goes beyond just room costs. Many hospitals link other costs, such as doctor’s fees, procedure costs and ICU costs, to the room category. By choosing a room from a higher category, these costs can increase proportionally, leading to a much greater financial burden than just the difference in room rent.
When requesting a refund, you must combine your business and personal policies. With business insurance, the insurer only reimburses up to the maximum amount of the room rent, including other costs related to the room rent. Your basic policy, which has no room rental limit, may cover remaining room costs and associated costs not covered by the company policy.
How should you go about it? Use business insurance first, as it typically has lower coverage limits. Submit the remaining costs to your basic policy for reimbursement.
But you need to verify some things beforehand. First, check with the hospital billing team to see how room upgrades will proportionately deduct other charges. Secondly, check whether your basic policy explicitly excludes proportional deductions caused by the room rental limit of another insurer or not. To avoid such problems, consider choosing a room that falls within the limit of your company policy.
You can also be completely confident that your basic policy provides sufficient cover for a room in a higher category. Discuss this information with your insurer or a confidential counselor before hospital admission.
If you combine both policies, you should take the following into account:
- Required Settlement Letter: After the business insurance company has settled its portion of the claim, they will issue a settlement letter. This letter describes the costs covered and the deductions. This document is mandatory for submitting a reimbursement application to your basic insurer. Without this your claim cannot proceed.
- Duplicate set of documents: To make a claim under the basic policy, you must submit a duplicate set of the original hospital bills, discharge summary and other supporting documents, duly stamped and certified by the company insurer. Obtaining this can be time consuming as it may take days or weeks for the business insurer to process and certify the documents.
- Time-sensitive process: Most insurers have a set time frame for filing claims, typically 30 to 60 days from the discharge date. If obtaining the necessary documents from the business insurer takes longer, you risk missing this deadline.
(Shilpa Arora is co-founder and COO at Insurance Samadhan)
