Regarding sublimit in insurance
10 months ago
I had a insurance policy which had a clause of sublimit or Rs 4,00,000 for Immunotherapy - Monoclonal Antibody to be given as injection. I had total expense of Rs 6,23,940 during hospitalisation and during the hospitalisation I received monoclonal injection of Rs 1,60,000 only. But the insurance company told me that my whole expense will come under sublimit. Is that correct or am I being misled!!!
A.Dear Client,
This claim by your insurance company depends on two factors:-
1) What the rest of the treatments other than the monoclonal antibody injection were,
2) and Whether these rest of treatments are counted as Immunotherapy according to your insurance policy.
Companies usually have different insurance policies and they have varied definitions of what does and does not count as Immunotherapy.
If your insurance police has clauses that include certain treatments you got along with the monoclonal antibody as Immunotherapy, then all of that might come under the sublimit.
For further advice, consult an advocate.
Thank you
When your health insurance policy is issued by the insurer putting a limit on your claim towards hospitalization expenses including the cost of diagnosis, treatments, medicines and other related expenses, you will not be reimbursed beyond that limit as per the terms of your health insurance policy. You may however escalate your claim before the grievance cell of the Insurer for a resolution.
Regarding insurance claim rejection
Hospital avoiding cashless treatment
Medical Insurance cancelled after 3 years
Legal Liability for Helper Covered If Death occurs by Gun Firing
Review of award by Insurance Ombudsman
