Work out claim settlement estimate instantly with clear inputs, formula shown and shareable results.
Claim settlement works through a sequence of deductions: non-payable consumables, sub-limits on specific procedures or room categories, then the copayment. The settled figure is usually 15-30% below the hospital bill even on a fully covered claim.
Admissible amount
Admissible = Total bill - Non-payable items - Sub-limit deductions
Settlement
Settlement = Admissible x (1 - Copayment %)
Indicative estimate only. Fees, entitlements, limits and formulas vary by jurisdiction, statute, policy wording and the facts of the case. This is not legal, tax, insurance or financial advice — confirm with a qualified professional or the relevant authority.
Gloves, syringes, administrative charges, food for attendants and similar consumables. Regulators publish standard non-payable lists.
Yes — request the itemised settlement sheet and challenge deductions that are not supported by the policy wording, via the insurer's grievance channel and then the ombudsman.