Some hospital plans apply pro-ration when an employee chooses a ward above their entitlement. Instead of paying each item in full up to its limit, the plan pays a set proportion of the whole bill.
For example, if a plan covers a 4-bed ward in a public hospital and the employee stays in a private hospital, the plan might pay only part of each item, leaving a larger share to the employee than the difference in room rates alone.
Not every plan pro-rates, and the rules differ. It is worth knowing which applies before a planned admission.