My corporate insurance has a room rent cap, but my retail insurance policy doesn’t have it. How will this impact my claim if I stay in a higher-category room?
– Name withheld on request
If a policy has a room rent cap, it can lead to proportionate deductions, which could significantly reduce the reimbursement amount from your insurance. Corporate insurance policies often include room rent limits, specifying the maximum daily cost they will cover for hospital stays. For example, if the cap is ₹5,000 per day and you choose a room costing ₹8,000, you will need to pay the difference out of pocket. The impact goes beyond just the room charges. Many hospitals link other costs, such as doctor’s fees, procedure charges, and ICU charges, to the room category. Choosing a higher-category room can proportionately increase these associated costs, leading to a much larger financial burden than just the room rent difference.
You should combine your corporate and retail policy when filing for reimbursement. In corporate insurance, the insurer will only cover up to the capped room rent amount, including room rent-linked other expenses. Your base policy, which has no room rent cap, can cover the remaining room charges and associated costs not covered by the corporate policy.
How to go about it? Use the corporate insurance first, as it typically has lower coverage limits. Submit the remaining expenses to your base policy for reimbursement.
But you need to pre-verify a couple of things. First, confirm with the hospital billing team how room upgrades impact other costs in proportionate deduction. Second, check whether your base policy explicitly excludes proportionate deductions caused by another insurer’s room rent cap or not. To avoid such hassles, consider choosing a room that falls within your corporate policy’s cap.
Alternatively, you can rely entirely on your base policy if it offers sufficient coverage for a higher-category room. Discuss these details with your insurer or a trusted advisor before hospitalization.
If you combine both policies, you need to be aware of the following:
- Settlement letter requirement: After the corporate insurance settles its portion of the claim, they will issue a settlement letter. This letter details the expenses covered and the deductions made. This document is mandatory for submitting a reimbursement claim to your base insurer. Without it, your claim cannot proceed.
- Duplicate set of documents: To file a claim with the base policy, you must provide a duplicate set of the original hospital bills, discharge summary, and other supporting documents duly stamped and certified by the corporate insurer. Obtaining these can be time-consuming, as the corporate insurer may take days or weeks to process and certify the documents.
- Time-sensitive process: Most insurers have a defined window for claim submission, typically 30-60 days from the date of discharge. If obtaining the required documents from the corporate insurer takes longer, you risk missing this deadline.
(Shilpa Arora is co-founder and COO at Insurance Samadhan)
