Why Claims Get Rejected at the Hospital Desk
Having a ₹10 Lakh or ₹25 Lakh health insurance policy gives a sense of security. Yet thousands of policyholders face unexpected out-of-pocket expenses during discharge due to fine-print policy covenants.
Understanding these critical clauses before purchasing or renewing your mediclaim will protect your life savings.
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1. Room Rent Sub-Limits and Proportionate Deduction Traps
Many standard policies cap daily room rent at 1% of the sum insured (e.g., ₹5,000/day on a ₹5 Lakh policy). *Danger:* If you choose a private room costing ₹8,000/day, the insurer doesn't just deduct the ₹3,000 room difference—they reduce doctor visits, surgery fees, and OT charges by 37.5% across your entire hospital invoice! *Solution:* Always choose a policy with 'No Room Rent Capping'.---
2. Co-Payment (Co-Pay) Clauses
A co-payment clause mandates that you pay a fixed percentage (e.g. 10% to 20%) of the total claim out of pocket. This is prevalent in senior citizen plans or location-specific policies. Avoid co-pay unless insuring elderly parents where comprehensive plans are unobtainable.---
