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If ICU rent is higher from my eligibility Prorata deduction is applicable for ICU

QuestionsCategory: Group Health InsuranceIf ICU rent is higher from my eligibility Prorata deduction is applicable for ICU
default avatarPlan Cover Staff asked 2 years ago
1 Answers

Best Answer

default avatarSrinivasan Mahadevan answered 2 years ago
If ICU rent is higher than the eligibilty in the health insurance policy than difference of the room rent alongwith the prorata deduction on the total bill of the hospitalization will be applicable.Proportionate deduction or incremental charges as per health insurance policy terms and condition is a condition which depends on the insurance plan. proportionate deduction is related to the room rent eligibility as per the insurance plan,when a policy has a capping for the room rent with a specific percentage and still insured opted higher room rent from his eligibility in the insurance plan then this proportionates or incremental charges is applied to overall expenses along with the room rent difference accept medicine and consumable cost in the bill. e.g. If a person has 3 lac Sum insured and room rent capping is 1% per and total stay in the hospital is 5 days,as per policy eligibilty is 3000 rupees per day but as per bill room rent is 5000 per day for 5 days opts for a room with rent higher than Rs 3,000,the other medical expenses in the hospital bill gets proportional deducted and the proportionate deduction will be about 60% as a room with higher rent had been opted. As a result, the claim gets partially paid by the insurer and the insured has to bear this amount.