If you take a room above your policy’s limit, the insurer pays the room only up to the limit, and cuts doctor, surgery and nursing charges in the same ratio. IRDAI does not allow that cut on medicines, implants, tests or ICU charges.
How the cut works
Your limit is ₹5,000 a day and you take an ₹8,000 room. The insurer pays 5,000 ÷ 8,000 = 62.5% of the room, and also 62.5% of the charges that go up with the room: doctor visits, surgeon, operation theatre, nursing.
- Hospital bill
- ₹3,52,000
- Room above the limit
- ₹12,000
- 37.5% cut on doctor, surgery, nursing (₹2 lakh)
- ₹75,000
- Medicines, implants, tests (₹1.2 lakh)
- Not cut for the room
- You pay
- ₹87,000
A ₹5,000 room would have cost you nothing extra.
Check before admission
- Your room limit: in the policy schedule, often “1% of sum insured a day” or “single private room”.
- Ask the hospital which room is within it, and for an estimate.
- No cut is allowed where the hospital charges the same whatever the room.
Last checked 3 Nov 2026 · by BachatLab