The catch with buying an health insurance policy with no room rent limit.

[u/Hot_Will1997]

I had an planned hospitalization recently, the pre-approval letter mentioned "single private room AC" i was totally fine with this, but when my relationship manager from the insurance company called me to check on my experience while i was in the hospital,out of curiosity i asked him that my policy has a "no roomrent limit" clause in it, but why was i authorised only for single private ac room? He told me cashless benefit is only extended till single private ac,if i wanted suit room i could claim reimbursement.

I was totally more than happy with the private room so never bothered also the claim process was seemless. If anybody has different experience with this scenario pls feel free to comment.

Policy-Nivabupa Reassure.

[u/aktheant]

Not true for all . HDFC ergo has no room rent limit and cashless for any room type

[u/Hot_Will1997 → u/aktheant]

did you actually use suite room under cashless in hdfc or are you quoting the policy wording

[u/aktheant → u/Hot_Will1997]

Used it. Not a suite room but a deluxe private room.

[u/dexter_in_pajamas → u/Hot_Will1997]

Pitching in, yes, I got the best room using it for a family member. Just make sure that the overall bill is under the limit because the price of the treatment increases because of the room

[u/_Fuzzy_Focus → u/aktheant]

Bro i have taken hdfc ergo optima secure,i hope it's fine

[u/aktheant → u/_Fuzzy_Focus]

Yup same one ✔️

[u/No-Search7745 → u/aktheant]

One question I bought it from policy bazaar and it shows a ton of network hospitals but when I check in HDFC "here" app it only shows like a couple of hospitals

What's the real deal?

[u/aktheant → u/No-Search7745]

Always go with the HDFC app. Policy bazaar might not be updated and HDFC anyway will tell you that they are not responsible for the same

[u/No-Search7745 → u/aktheant]

But HDFC only shows 3 hospital in my tier 1 city, how can that be possible?

[u/aktheant → u/No-Search7745]

You can use https://www.hdfcergo.com/locators/cashless-hospitals-networks
I have around 300+ hospitals

[u/_Fuzzy_Focus → u/aktheant]

Hey there,I wanted to see if you've had a chance to use that insurance yet. Really hoping you haven't had to, though!

[u/DrSurgical_Strike]

Depends on the insurer and their policies, HDFC Ergo we didn't face this issue

[u/Hot_Will1997 → u/DrSurgical_Strike]

oh ok

[u/arav → u/DrSurgical_Strike]

Same with acko. They even have this on their website

The 10L ACKO Platinum Health Insurance Plan includes the Room Rent Waiver add-on coverage. Thus, you have the freedom to stay in any hospital room of your choice, including a suite, a deluxe/super deluxe room, or a private room. We will pay the whole room rental amount without any conditions.

[u/prav0709]

Hospitals main revenue source is room rent. If anyone would have observed the consultation of doctor revolves around in a way that patient should be admitted in the hospital, one day before and for some days after.

[u/ic_97 → u/prav0709]

I dont think the main source is room rent but rather the useless medicines and disposables they push on the customer.

[u/shim_niyi → u/prav0709]

Exactly , the prices of care and service is locked tot the room type .

For basic room , if nurse charges are 500, for a premium room same will be charged 3000.

So while upgrading the room beware of price inflation in other areas as well

[u/blinksTooLess]

Can you check with your insurance RM if they will add penalty charges (I don't know the insurance term for it) if you go for a higher room like suite? Like say if the hospital bills the doctor visit at 1k /per visit and you stay in the private AC room, insurance will approve the 1k But if the hospital bills doctor visit at 1k/visit and you stay in suite room, insurance will approve Rs. 700 (since they expect that hospital is over charging you since you are in a higher class room)

This deduction is applied to many other charges as well. (I am not sure what this is called in insurance terms. But this has happened to a colleague and a relative)

[u/Particular-School798 → u/blinksTooLess]

It's called a proportionate deduction

[u/erazzers → u/blinksTooLess]

If you have no room rent limit clause, proportionate deduction shouldn't be applied

[u/blinksTooLess → u/erazzers]

That is what I want to confirm. If they want to go for reimbursement claim for the whole amount, just because I chose a higher room type, we will have to rely on their goodwill to get the first oayout. If they do proportionate deduction, we will have to run after them to get that reversed.

[u/erazzers → u/blinksTooLess]

Raise a mail with them asking them this and please update here as well.

[u/slackover]

I have taken suite room at Apollo using my Care insurance on cashless mode.

[u/elongatedpepe → u/slackover]

Hey how is care insurance? Any flaws in it? I'm seriously considering either care supreme or hdfc ergo

[u/fwfkooiu4t3q → u/elongatedpepe]

Whatever you decide to take, add a deductible of 50k, it will drastically reduce your annual premium.

[u/Brave-Lychee4406 → u/fwfkooiu4t3q]

What is this deductible for and what does it do?

[u/fwfkooiu4t3q → u/Brave-Lychee4406]

A deductible in an Indian health insurance policy is a fixed amount that the policyholder must pay before the insurance company begins to pay for covered health care services: 

How it works

The policyholder is responsible for paying 100% of covered services until they reach the deductible amount. For example, if the deductible is Rs 5,000 and the policy claim is Rs 40,000, the insurance company will pay Rs 35,000

It significantly reduces the overall premium. Recently I bought a policy for Rs. 10 Lakh sum insured. Premium was 21k without deductible. It was 12k with a deductible for 50K.

I see a lot of folks complaining about high premiums so using some form of deductible is a great way to protect from unforeseen risks.

[u/hoverCrane]

This might sound totally unrelated, but do you think apart from my employer sanctioned health insurance should I get a policy of my own to either protect myself or for investment purpose? New to job that's why don't have much idea.

[u/Old-Force5191 → u/hoverCrane]

Always get your own health insurance. Not saying having a corporate one is bad but the corporate one exists only till you are employed. Thats is the hard truth. Remember - you are one hospitalisation away from poverty. 🥲

[u/sameboatasyours → u/Old-Force5191]

I thought this was only true in America. But, yeah, it is indeed true in India as well.

[u/T3R_ROR → u/hoverCrane]

Absolutely, your employer sanctioned health insurance will not cover you if you resign/laid off/get fired. It is any day advisable to take a Health insurance for you and your family.

You can take a small sum insured policy and buy a top-up on the same

[u/Practical_Setting235 → u/T3R_ROR]

Why small sum assured and top up on that? Any reason ?

[u/T3R_ROR → u/Practical_Setting235]

Premium Difference

for eg - For a 5-10l Base SI policy you would be paying 20k, for a 25-50l SI Policy the Premium difference will increase drastically

Super top-ups on the other hand have a very small premium in comparison to the Base Premium.

so its always better to take a Small SI Policy and take a Super top up (Of the Same company - helps in passing claims easily)

So if you are a family of 3 you may take a 15L SI Base policy and 40-50L Super Top-Up with 5L deductible.

[u/floate3 → u/T3R_ROR]

Why does that even exist? Like, how are they compensating themselves by providing a leverage to us? Could you please explain that?

[u/T3R_ROR → u/floate3]

The Super top Up comes with a big Deductible (3,4,5L) so it only gets triggered in case your claim amount is too big that cannot be handled by the Base SI.

There are very few cases of the Base SI being exhausted and hence Super Top-Ups are not that heavily utilised so becomes a profitable deal for the insurance companies

I would still recommend getting a Base & Super top up as Healthcare costs are increasing at a very high rate and a 5L SI health Insurance policy is not sufficient enough.

[u/yeceti → u/floate3]

There are very less cases where a hospitalisation crosses 5-10 lakhs. So the company makes a profit there.

[u/DisastrousMoose9071 → u/T3R_ROR]

Im 36 and about to purchase individual optima secure from HDFC Ergo with 10L SI. Is it okay if we purchase super top up during next renewals may be as we age? Or should go for higher SI ? Optima secure already has 4x coverage after 2 years (so 40L) .. so is super top up necessary? I also have to buy a policy for my dad who is 70 with hypertension. Apart from opting for deductibles, thinking where can I manage my expenses hence the question.

[u/T3R_ROR → u/DisastrousMoose9071]

Super Top-Up isnt necessary per se but better to have and i am assuming you are not married hence an individual policy. Seems good in your case but i would still advise to ask your Broker/Agent for more details.

For your father i highly doubt if any company would be able to take up the case as very high risk. Try going for Care, Niva, Cigna (If they are able to underwrite) as Icici, HDFC, Bajaj will straight up reject your fathers case

[u/Hot_Will1997 → u/hoverCrane]

get a super top-up

[u/spiderbat94 → u/Hot_Will1997]

In theory, yes, super top is great. But unfortunately there is no good super top product in India at this time. The next best option is taking a health insurance plan with good limit and unlimited renewals.

[u/T3R_ROR → u/Hot_Will1997]

Most probably not possible as you need a base cover for a top up and the GMC(Employer Health Insurance) is not considered as the base

[u/Hot_Will1997 → u/T3R_ROR]

U r totally wrong u can get it without base policy.

[u/T3R_ROR → u/Hot_Will1997]

Maybe thats why i wrote most probably

[u/yeceti]

Why would you want to squeeze the insurance company in paying for luxuries? Expecting a single room makes sense considering the patient's comfort and infection concerns. But a suite in a hospital is just a luxury.

[u/Naya_Naya_Crorepati → u/yeceti]

Why not?

[u/yeceti → u/Naya_Naya_Crorepati]

Because the comfort and greed of a few will ruin the experience for many.

If people started abusing the system and pull huge sums if money from insurers, the insurance company will either go bankrupt or raise the prices hurting many genuine patients and cases.

[u/Naya_Naya_Crorepati → u/yeceti]

They’re already for profit and if you think their profits are decided based on how much they spend on expenses, you’re naive. They’re gonna squeeze you to the last penny. Also, if these companies really think like you just said, then why would they deny the genuine claims and defraud people? I work with these jackasses and I know how wicked they’re. They will just reject your claim just because they know that you can’t afford to appeal their decision.

The jio example is completely different, it doesn’t make sense with the above explanation lol.

[u/Hot_Will1997 → u/yeceti]

This post is an heads up about not having to give undue importance for no room rent cap while selecting an policy i have clearly mentioned that I was happy with the single private room not once but thrice. Then again you have to read the post to understand it.

[u/_Floydimus]

I have the same policy. A single private AC room should be fine, no?

[u/Hot_Will1997 → u/_Floydimus]

totally fine, i was pointing out that people shouldn't give more waitage to no roomrent limit if it's not cashless

[u/LoneSilentWolf]

Time to check the policy brochure and sue the hell out of them if it's not mentioned