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What is Disease wise capping? What are the diseases covered under this and what is the capping for each ailment?

QuestionsCategory: Group Health InsuranceWhat is Disease wise capping? What are the diseases covered under this and what is the capping for each ailment?
default avatarPlan Cover Staff asked 5 months ago

1 Answers

Best Answer

default avatarSrinivasan Mahadevan Staff answered 5 months ago
Disease wise capping is the maximum limit payable by the insurer for a particular disease under the policy. There are some disease which are capped with the percentage or a specific amount by the insurance company during the inception of the policy,which means during the policy period if someone has claim for capped diseae in that only that percentage or capped amount will be approved at the time of hospitalization. Disease wise cappings vary insurance to insurance there are some common diseases which covers in the policy,i.e. Cataract,Hernia,Piles,Hydrocel,Calculus,Appendix,Hysterectomy,Knee Replacement,Hip Replacement,PTCA,CAG,TURP,Renal Stone etc,these diseases can be capped in the group health insurance at the time of inception to reduce the cost of premium or control the claim ratio in the policy to avoid the higher premium cost at renewal time. each disease capped with a specific amount and capped amount will be decided at the time of policy purchase or renewal time. Example: some policies has capped cataract limit it could be 10K to 50K depends on plan,Hernia,10K to 50k,Piles same with the others diseases can be covered 10K to 1 lac minimum, As per the insurance claim data these are the very common and frequent diseases and the cost of the treatment for these disease are vey high that is why insurance company advised to capped these disease so that loss ratio of the claim can be control and reduce the cost of premium in the policy.

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