5 Hidden Clauses in Health Insurance That Can Cost You Big

Health insurance is essential for managing medical expenses. However, some policies have hidden clauses that can surprise you during claims. Here are five crucial ones to watch out for:

Room Rent Limits

Most policies have a cap for the daily room rent they cover. If the room exceeds that limit, the remaining will be borne by you. For example, the policy of ?10 lakh has ?3,000 as the room rent limit per day, so higher room rents are very expensive.

Co-Payment Clauses

The co-payment refers to the percentage of costs that you share toward medical expenses. A policy with a 20% co-payment means ?20,000 of a ?1 lakh bill would be paid by you. This provision reduces the premium on the insurance policy while maximizing your out-of-pocket expenses.

Waiting Periods for Pre-Existing Conditions

Most policies have waiting periods for pre-existing conditions, often up to 36 months. Claims related to these conditions during this period aren't covered. Choosing policies with shorter waiting periods is advisable.

Reasonable and Customary Charges

Insurers may limit payouts based on their assessment of reasonable charges, even if your actual costs are higher. This can lead to unexpected expenses if your hospital charges exceed the insurer's standard.

Sub-Limits on Specific Treatments

Some policies impose sub-limits on treatments like cataract surgery or ambulance fees. Even with a high sum insured, these caps can restrict claim amounts for specific procedures.