What is unlimited health insurance and how does it work?

Unlimited health insurance cover at first may sound enticing, nonetheless, it does not literally mean that your insurer will pay for just anything and everything infinitely. Primarily, the concept of unlimited health cover with unlimited sum insured has emerged to cater to the rising medical costs. Herein, your insurer pays for the eligible medical costs with no upper limit on the total amount that can be claimed in a year.

Some of the unlimited health coverage plans currently on offer include, ICICI Lombard’s Elevate plan, Bajaj Allianz’s Health Infinity policy and Future Generali Health Unlimited plan among others.

In the Indian insurance space, unlimited health coverage is offered as under:

No set limit on sum insured value: As against the conventional plans that come with a set sum insured value (for eg: ₹10 lakh or ₹20 lakh), these plans have no maximum limit, letting the insured claim the entire cost of eligible medical treatments, hospitalization etc.

Restoration: In some of the plans, ‘unlimited’ cover is obtained via unlimited restoration of the sum insured i.e. once you exhaust the initial cover in respect of some illness or hospitalization, the insurer on its own replenishes the amount for any future hospitalisations in the same year. Say for instance, if you have a cover of ₹20 lakh and you use it fully then the insurer replenishes the coverage for the next claim. However, this may work for some of the illnesses based on the policy document.

While the 'unlimited' health cover allows you to claim infinitely, you may still have to bear the below specified costs:

1. Co-pays: The insured may be required to pay some percentage of the total admissible bill himself as part of the co-pay clause. So, in any case if your co-pay stands at 10%, you will be required to pay 10% of the total bill every time you take the treatment.
2. Deductibles: Whether the plan is ‘unlimited’ or not, if deductible is decided at ₹25,000, you have to pay that first. A deductible in the insurance parlance refers to the amount you are required to pay out-of-pocket in respect of covered claims before the actual insurance benefit kicks in.
3. Disease-specific sub-limits: Irrespective of the 'unlimited' tag, the insurer may cap their pay-out in respect of certain ailments or medical procedures such as knee replacement etc.
4. Limits pertaining to room rent: These plans typically specify the type of hospital room you are eligible for i.e. a semi-private or private etc. In case you go for a higher-end room, proportionate deductions will be made in your total bill, meaning you will be required to pay for the differential.

Who should opt for unlimited health cover?

The unlimited health coverage will be suitable for: Individuals with a critical medical history in the family. Individuals with elderly parents who are in need of constant medical care. Individuals who have critical pre-existing ailments. Individuals who foresee high medical treatment expenditure. Individuals seeking to get medical aid at a high-end hospital Individuals who wish to secure a financial cushion for medical emergencies