GIPSA, PPN and Empanelment in Health Insurance - Explained
GIPSA, PPN in GIPSA, Points to remember before opting GIPSA services, hospitals, empanelment
February 20, 2023
Table of contents
Hospital room rent is nothing but the per-day charges the patient has to pay towards occupying an ICU room or a hospital ward room during hospitalization. This can be a deluxe room, luxury room, etc.
Now they can have a sub-limit applied to them commonly known as room rent limit. This is directly related to your sum insured. Your room rent limit is a percentage of your sum insured. This percentage is prescribed by the insurer.
A sub-limit in health insurance is the specific percentage of the sum insured which will be paid by the insurer for certain hospital expenses generated. There can be different sub-limits for different hospital expenses. Doctor’s fees, room rent, nursing expenses, and many more can have a sub-limit cap applied to them. However, they depend on the terms and conditions of your health insurance policy.
Sam goes to a hospital for surgery and he requires hospitalization of 5 days. He decides to take up a private room which costs him ₹6000 a day. He has a sum insured of ₹5 lakhs. His insurer has the room rent limit of 1% of the sum insured, which is around ₹5000 a day. Summing the details up,
Here is what Sam’s hospital bill will look like:
So, from the above bill, you can see that the actual cost of room rent is ₹30,000. So according to the prescribed 1% room rent limit, the insurer will pay you only ₹25,000 and you will have to pay the rest which is ₹5,000 out of your pocket.
Now let us turn the tables. Let us consider that Sam opts for a health insurance plan with no ICU room and hospital room rent limit. What happens then?
Very simple, Sam can opt for whatever room he wants and the insurer takes care of the entire room rent expense.
Typically what every insurer does is that they give you a limit up to which you can choose your ICU room and hospital room when you undergo treatment.
The average private room charges in a hospital can vary according to a few factors.
Now considering all these factors, let us understand what a typical room ret charges will look like. Let city A be a metropolitan city and C a non-metro city and B a city that falls in between them.
Please note: The above-mentioned costs are for reference purposes only and not the exact costs. They may vary according to the hospital you choose.
In the previous situation we explored what a room rent with sub-limit looks like. Now there are other types of room rent coverage in health insurance. They are
With a health insurance plan which mentions room rent without sub-limits, the policyholder has the freedom to choose any room he wants without any restriction. General ward or a private room, the choice is yours. A health insurance plan with no room rent capping is an ideal policy to go with.
No room rent capping meaning in insurance is there is no restriction on which room or price you choose your room when you’re hospitalized.
In a room rent with a co-payment option, the insurer specifies the room rent limit during hospitalization. The insured will have to pay the rest of the amount if the room rent crosses the prescribed limit. This is what Sam’s situation was like too. In this way, you can share the room rent payment with the insurer.
Some health insurance companies mention the room types in advance for which the health insurance cover is applicable. So you can choose any one of the pre-mentioned rooms for hospitalization and room rent for the same will be provided by the insurer. In case you want to choose a different room, then you will have to pay for it out of your pocket.
A few health insurance companies let you buy a no room rent limit option as an add-on cover for an extra premium. So with this plan in place, you do not have to worry about the room rent limit.
Remember these pointers to purchase the right insurance for ICU room and hospital room rent.
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