Sub Limits: The sub limits are limits imposed on the different sections of expenses involved in the cover. It puts a maximum limit to which the insurer would pay for a particular expense incurred during a treatment e.g some insurance companies put an upper limit to the room rent it would reimburse. So in such cases if the expense incurred by you exceeds the limit mentioned by the insurer, than the remaining amount needs to be paid by you. There would be other sub limits like doctor's consultation.
Day Care Treatments: There are certain diseases or treatments which are covered even through it does not require 24 hours hospitalization which in general is a mandatory clause. This could be due to the change in technology resulting in less time for treatment. e.g Cataract surgery.
Medical Tests: Companies have a list of predefined medical tests which an individual is required to undergo if the individual is above age 45 or sum assured asked for exceeds a certain amount. The requirement to undergo tests varies. Also these tests are completely paid by the insurer.
Network Hospitals: There are hospitals which have a tie up with insurance companies to provide cashless treatment. On the basis of the health card provided by the TPA (Third Party Administrator) you are eligible to get treated without any payment.
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