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Build a transparent claim waterfall for non-payables, room-rent eligibility, supported proportionate deductions, sub-limits, deductible and co-pay.
Enter the facts and calculate. The result appears here.
Build a transparent claim waterfall for non-payables, room-rent eligibility, supported proportionate deductions, sub-limits, deductible and co-pay.
Health-insurance claims are policy-wording driven. This estimator therefore refuses to invent a universal room-rent deduction formula. A proportionate linked-charge deduction is applied only when the user explicitly confirms that the policy/claim basis supports it.
The result separates non-payables, direct room shortfall, linked-charge reduction, sub-limit, deductible and co-pay so users can compare the insurer’s claim sheet line by line. Do not duplicate the same deduction in more than one input bucket.
Actual admissibility can depend on package rates, network arrangements, reasonable-and-customary clauses, consumables add-ons, disease/procedure sub-limits and policy-specific exclusions. Those cannot be safely inferred from a few numbers.
Use this page as a reconciliation tool: enter the insurer’s own policy limits and claim basis, then investigate exactly which stage creates the gap. A large unexplained difference is a prompt for policy/claim review, not proof that the insurer is wrong.
Every field below changes the result. They are listed exactly as the form asks for them.
| Field | Type | What it controls |
|---|---|---|
| Total hospital bill | Number | |
| Non-payable / excluded items (excluding room shortfall and linked-charge reduction entered separately) | Number | |
| Actual room charges | Number | |
| Eligible room charges under policy | Number | |
| Charges actually linked to room-rent proportion, if policy/claim basis supports it | Number | |
| Apply proportionate linked-charge deduction? | Choice | 2 options: No / not established; Yes — supported by policy/claim basis |
| Claim sub-limit, if applicable (0 = none) | Number | |
| Deductible | Number | |
| Co-pay (%) | Number |
Estimated insurer payable = admissible bill after explicit exclusions/room shortfall/supported proportionate reduction/sublimit, less deductible, then co-pay.
The engine validates required values before calculating and rejects impossible combinations instead of converting them to zero silently. Dates, thresholds and category switches that drive the result remain visible to the user.
The logic on this page is built from the instrument(s) below. Where a rule did not clearly cover a scenario, that scenario is excluded rather than estimated.
The most common error in regulated calculations is not arithmetic; it is putting the facts into the wrong legal or product category. Check the transaction, entity, holding, policy or taxpayer classification before relying on the number.
Keep statements, acknowledgements, invoices, policy schedules, complaint IDs, tax workings or orders that support the inputs. A number without an evidence trail is difficult to defend in a complaint, return, claim or review.
Rules can change. This page records a source-check date, not a fabricated professional review date. If the event belongs to an older period, confirm that the rule version used here applies to that period.
No. The exact treatment depends on policy wording and claim basis; the tool applies proportionate linked-charge reduction only when you select it.
It is the amount applied before the insurer share under the entered policy structure.
It is the entered percentage of the post-deductible admissible amount borne by the insured under the model.
Not necessarily. Final settlement can differ after discharge documents and claim adjudication.
No. It helps identify and quantify deduction components for a grievance or clarification.
Source links below are the authority trail used to design the current rule logic. They remain more important than a generic secondary explainer.
Source checked: 14 August 2026. This denotes source verification for the package, not CA/legal review or approval of the individual case.
These cover adjacent decisions. Each owns a different question, so use the one that matches your actual event.
This calculator is published for general information and educational purposes only. It is not legal, tax, accounting or investment advice, is not personalised to your circumstances, and is not a substitute for reading the governing instrument or taking professional advice on your facts. Finin2min records a source-check date, which denotes verification of the authority trail and not a professional review or approval of any individual case.
Scope: Computes interest on delayed GST tax payment under Section 50 of the CGST Act.
Source checked: 14 August 2026. This records verification of the source trail on that date. It is not a professional review or approval of any individual case.
Background, worked examples and the rules behind these numbers.