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Health Claim Payout Calculator
Result
Chart
Show formula & working
Proportion paid = eligible room rent ÷ room rent charged (when the room is above the limit and the hospital bills by room category)
Allowed = room up to the limit + ICU (up to any ICU limit) + associated expenses × proportion + pharmacy, implants and diagnostics (in full unless your policy cuts them) · Payout = min[(allowed − deductible) × (1 − co-pay), sum insured]
Details
IRDAI norms on proportionate deduction in health claims (2020, now superseded): rates and rules as of 11-Jun-2020 · Source: IRDAI circular IRDAI/HLT/REG/CIR/151/06/2020 (11 June 2020), Modified Guidelines on Product Filing in Health Insurance Business — Norms on Proportionate Deductions (paras 3–7). Every figure based on it stays editable.
How this works
Many policies cap room rent. Choose a costlier room and the excess is not paid — and the 'associated medical expenses' your policy defines are paid only in the same proportion.
IRDAI's 2020 norms kept pharmacy and consumables, implants and devices, diagnostics and ICU charges out of these cuts, with no cut where the hospital charges the same whatever the room. That circular was superseded by IRDAI's Master Circular on Health Insurance Business of May 2024, which does not restate these norms; most policy wordings still follow them, but your policy wording decides.
Frequently asked questions
Which charges are cut in proportion?
Only the 'associated medical expenses' your policy defines — often doctor, nursing and OT charges that hospitals bill by room category. Set the switches to match your policy.
Does a no-room-limit policy avoid this?
Yes. Policies without a room-rent cap do not apply proportionate deduction.
What are non-payable items?
Items the policy lists as not covered, such as some consumables and admin charges, unless an add-on covers them.
Is this the final claim amount?
It is an estimate. The insurer's assessment under your policy wording decides.
Reviewing your cover?
Talk to Rytvae about how much cover you need and what your policy wording really pays.