Sample report · fictional policy
What a Claim Saathi read looks like
This is a worked example on a made-up policy — no sign-up needed. Every real answer follows the same shape: the point first, the money at stake, the reason, the exact clause as evidence, what’s still uncertain, and one clear next step.
Policy (illustrative)
Niva Bupa — ReAssure Plus
Sum insured
₹10 lakh
Room rent limit
₹10,000/day (1% of SI)
The answer
Your room rent is capped at 1% of the sum insured — about ₹10,000/day. Choosing a room that costs more than that doesn’t just cost you the difference; it can shrink the entire hospital bill your insurer pays.
What it could cost
On a ₹1,00,000 hospitalisation where you took a ₹15,000/day room (eligible: ₹10,000), the insurer can pay only ₹10,000 ÷ ₹15,000 ≈ 67% of the covered charges — roughly ₹67,000 paid, ₹33,000 borne by you as a “proportionate deduction”.
Why
Many indemnity plans tie several charges (room, nursing, doctor visits, some procedures) to the room category you choose. Pick a costlier room and those linked charges are scaled down to your eligible room’s level — so the deduction lands across the bill, not only on the room line.
Evidence
Niva Bupa — ReAssure Plus · IRDAI UIN NBHTGXX00000V000000 · §4.2 Room Rent
“If the Insured Person opts for a room with rent higher than the eligible limit, the Company shall pay the Associated Medical Expenses in the same proportion as the eligible room rent bears to the actual room rent incurred.”
What we can't tell yet
Some variants waive proportionate deduction above a threshold sum insured, or exclude high-end procedures from scaling. Your policy schedule and the plan variant decide this — we’d confirm it against your uploaded document before relying on the figure above.
Your next step
At admission, ask for a room at or below your eligible limit (₹10,000/day here). At renewal, consider a plan with no room-rent capping — it removes this whole risk.
See this for your own policy
Paste or upload your policy and get your own plain-English read in about a minute — free, no card.
Check my policy — free⚖️ Illustrative example only — a fictional policy with round numbers to show the format. Not legal, medical or financial advice, and not a guarantee of any claim outcome.