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Why It Is Important to Check the Sub-Limits in Your Health Insurance Plan? | 3154


Why It Is Important to Check the Sub-Limits in Your Health Insurance Plan?

WhatsApp Image 2023 06 13 at 7.16.29 AM

A health insurance policy comprises a vast range of features, inclusions, exclusions, and various other elements. It is important to pay proper attention to each and every aspect of a health insurance policy while making a purchase so as to prevent last-minute issues. One such feature that one can find in their health insurance policy is sub-limit. To have a better understanding of sub-limit and how its presence impacts a health insurance policy, let us go in detail.

What Is Sub-limit?

Sub-limit can be described as a health insurance policy clause that acts as a cap, which the health insurance company puts for a policyholder on expenses against a specified medical procedure. In other words, sub-limit is the extent to which a health insurance company pays for claims arising out of associated medical expenses. Sub-limit is usually predetermined by the health insurance company on the total amount of claim for some specific or medical treatment. Hospital room rent, ambulance charges, consultation fee of a doctor, plastic surgery, knee ligament reconstruction, cataract operation, and a few pre-planned surgeries are usually subjected to sub-limit.

How Sub-Limits Affect Health Insurance Policy?

Health insurance companies provide the clause of sub-limit in their health insurance policies so as to minimize their overall claims outgo or limit their liability to pay to the policyholders. Another reason for introducing sub-limits in health insurance policies is reducing fraud as well as unwarranted inflated medical bills by policyholders.

From the perspective of policyholders, sub-limit is a health insurance policy feature that may refrain them from a full claim amount against their health insurance policy. In other words, sub-limits in health insurance reduce the claim amount, thereby increasing the out of pocket expenses of the policyholder.

It is, therefore, very important to check if a health insurance policy that you are interested in purchasing has a sub-limit clause. Being aware of the presence of the sub-limit clause will help you prepare accordingly and prevent the last minute disappointment of not being able to enjoy a full claim.

Some Important Questions Regarding the Sub-Limit Clause

As a policyholder, you can have a few questions in mind regarding the sub-limit feature. For your convenience, the list of prime questions regarding sub-limit is as follows:

1. Do all health insurance policies come with the sub-limit clause?

No, all health insurance policies do not feature the sub-limit clause. There are a few health insurance companies that impose sub-limit on specific conditions and treatment.

2. Is the sub-limit amount defined by the IRDAI?

No! IRDAI does not have any rule specifying the clause of sub-limits in a health insurance policy.

3. I want to check a health insurance policy for sub-limits. How can I do so?

If you want to check the sub-limit clause in a health insurance policy, make it a point to carefully read all the terms and conditions present in the policy document. You can also contact your health insurance company regarding the sub-limit clause in that specific policy.

4. Is the clause of sub-limits applicable to reimbursement claims?

Yes! Sub-limits are applicable to reimbursement claims. Remember, these sub-limits are decided by the health insurance company. Also, that they are applicable to the claim, no matter it is a cashless claim or a reimbursement claim.

5. Can I opt-out of the sub-limit clause in a health insurance policy?

If you want to opt-out of the sub-limit clause, firstly you will have to check whether or not the health insurance company provides you the flexibility for the same. Learn that if the health insurance company allows opting out of the sub-limit clause, you would be required to pay an extra premium in its place. Whether you are fine with the sub-limit clause being imposed on your policy or paying an extra premium is something that you will have to decide to keep your budget in mind.


It is a common practice among health insurance customers to avoid health insurance policies with a sub-limit clause. You too can avoid a policy with sub-limits. However, if you decide to go with a policy having sub-limits, you should be prepared to pay from your own pocket as well. No matter what you choose, make sure you read the policy terms and conditions carefully.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard


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