India travel insurance sub-limts vs no sub-limits

Travel Sublimit

Sublimits Definition

Sublimits are specific constraints or limits in an insurance policy's cover for certain losses or medical expenses. These sub-limits are part of the original medical maximum coverage amount, which means that the sub-limits do not provide extra coverage but are a specified maximum limit to cover a specific situation. Sublimits may be either expressed as a Dollar amount or as a percentage of the total coverage available.
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Difference between plans having sub-limits and not having sub-limits

Insurance plans with Sublimts Insurance plans with no Sublimits
Definition These plans have specific limitations on the coverage available to cover different medical expenses. These plans cover up to the available maximum without any limits for specific treatments
Coverage Limits on medical expenses, affordable, ideal for small expenses Provides extensive coverage, more expensive, offers coverage up to the chosen plan maximum
Premium Cost Cheap and affordable Higher premiums

How do these plans work?

Example: Plan with sublimits

Let us take an example where the medical bill is $25,000.
Deductible is $100 - First $100 the customer needs to pay before the insurance company pays.
The plan covers up to a maximum of $50,000.
The insurance company only pays limited amount for the expenses, assuming the following breakdown:

Expense Amount Billed Plan Pays Customer Owes
Ambulance $700 $400 $200 + $100 (deductible)
Hospital Room Rent $8,000 for 4 days $6,000 for 4 days $2,000
Surgical Treatment $16,000 $10,000 $6,000
Physician’s visits $400 for 4 days $300 for 4 days $100
Total $25,100 $16,700 $8,400

Example: Plan without sublimits

Let us take an example where the medical bill is $25,000.
The plan covers up to a maximum of $50,000.
Deductible is $100 - First $100 the customer needs to pay before the insurance company pays.
The insurance company pays full amount for the expenses after the deductible is paid by the customer, assuming the following breakdown:

Expense Amount Billed Plan Pays Customer Owes
Ambulance $700 $600 $100 (deductible)
Hospital Room Rent $8,000 for 4 days $8,000 for 4 days $0
Surgical Treatment $16,000 $16,000 $0
Physician’s visits $400 for 4 days $400 for 4 days $0
Total $25,100 $25,000 $100
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