What it does
Many Indian health policies limit the room rent per day, often to 1% of the sum insured for a normal room and 2% for ICU. If you choose a room that costs more, the insurer may pay the room, nursing, doctor and operation theatre lines only in proportion. That is called proportionate deduction, and it can cut a bill by far more than the extra room rent.
This tool shows the cut line by line, what the insurer pays, and the highest room rent with no cut at all. The numbers are examples: change them to yours. To weigh plans before you buy, use the health plan cost comparer, and to fit the premium into your month, the budget planner.
How to use it
- Enter the sum insured and whether the limit is a percentage of it or a fixed amount a day.
- Enter the room rent per day you chose, the days, and any co-pay.
- List the hospital bill lines. Tick “cut in proportion” for the ones the cut applies to.
- Read what the insurer pays and what the room choice cost you.
What each setting does
- Limit as % of sum insured: 1% of 5,00,000 is 5,000 a day. Choosing ICU fills in 2%.
- Room you chose: if it is above the limit, the cut applies.
- Cut in proportion: tick for room, nursing, doctor and surgeon fees, operation theatre. Leave it unticked for medicines, implants, consumables and diagnostics, which IRDAI’s rules say are not cut this way.
- Co-pay: the share of every claim you pay after the cut.
Worked example
Limit 5,000 a day, room chosen 8,000 a day. The ratio is 5,000 ÷ 8,000 = 62.5%. Room charges 24,000 and doctor fees 40,000 (both ticked) are paid at 62.5%: 15,000 + 25,000. Medicines of 30,000 are paid in full. The insurer pays 70,000 and the room choice cut 24,000.
FAQs
Does every policy do this? No. Some have no room limit. Check your policy wording and the official IRDAI text.
Why is the cut so big? It applies to the whole ticked bill, not only the room.
Is the number final? No. The insurer’s own assessment decides it.
How it’s worked out: ratio = limit ÷ room rent chosen (at most 1); ticked lines × ratio; then co-pay; the insurer pays at most the sum insured.
Where the numbers come from
- IRDAI master circular on health insurance business (2024), on proportionate deduction: not applied to medicines, implants, consumables and diagnostics. Checked 2026-11-10, check the official source and your policy wording.
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Last updated 2026-11-10.