For patients
What a room rent cap actually costs you
A policy that caps the room at one per cent of the sum insured does not just limit the room. Here is the arithmetic, with your own numbers.
Illustrative, and your policy decides the cap. Redo it with your own sum insured and your own room rate — the mechanism does not change.
What is a room rent cap?
A limit on what the insurer will pay per day for the room, usually stated as a percentage of the sum insured — often one per cent for a shared room and two for a private one. On a five lakh policy that is five thousand a day.
What happens if I take a better room?
You pay the room difference, and the insurer also reduces every associated charge in the same proportion. That second part is what surprises people, and it is in the policy wording rather than hidden.
How do I avoid it?
Ask the hospital, before admission, what the room costs and what your cap is. Both numbers exist and both are knowable at that moment. After the patient is in the room, the arithmetic is fixed.
We are not selling you anything here.
Drapto makes software for clinics. This page exists because the question is common and the answers online are poor. There is nothing to sign up for and nothing to buy.
If a claim was cut, you are allowed to ask why.
These pages are written for the person holding the letter, not for the hospital.