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What is Co-Pay in a Health Insurance Policy?

IamCheated.com Research Team | July 10, 2019  5:43:pm

What is Co-Pay in a Health Insurance Policy?

Hospitalization costs in India are rising each year. When compared to the last 10 years, you can see a dramatic rise in medical expenses. The health insurance plan makes sure that medical expenses are not paid out of pocket.

If you do not have a health insurance plan, medical expenses can blow a hole in your pocket and land you in the debt trap.

With the increase in medical costs, premiums of health insurance plans are on the rise. As the cost of health insurance cover rises, health insurance companies have come up with co-pay in health insurance plans.

See Also: Don't Ignore These While Availing Health Insurance

What is Co-Pay?

The co-pay clause in the health insurance plan says that the policyholder will have to pay part of medical expenses out of pocket and the remaining amounts are paid by the insurance company.

Now, many insurance companies have co-pay clause in the health insurance plan. The proportion of co-pay in health insurance plan, lies anywhere between 10 to 25%.   


Let’s consider you have availed a health insurance plan with sum assured of Rs 5 Lakh with 20% co-pay and then made a claim of Rs 1 Lakh for a medical emergency. In this case, you have to pay Rs 20,000 as co-pay out of your pocket and the remaining amount of Rs 80,000 will be paid by the insurance company.


Features of Co-pay:

1. It is an amount paid by the policyholder out of pocket, for medical treatment.

2. Co-pay is a small percentage of medical expenses, while the remaining amount is paid by the insurance company.

3. Co-pay is applicable to the health insurance plan availed by senior citizens. 

Is co-pay good for you?

Co-pay is not beneficial to all people. If the policyholder expects claims to be made in the near future, he may not find value in co-pay. The policyholder might find great value in availing health insurance with co-pay, if he is not expecting to make a claim in the near future.

If you are young, opt for co-pay feature in the health insurance plan, as you can save money on the premiums. Within a few years, you can really save a lot of money. 

If you are a senior citizen, you must not choose co-pay feature in health insurance, as medical expenses are quite high in old age. This will increase the co-pay amount.

Without any doubts, co-pay really helps save on the premiums. But, before availing health insurance with co-pay, make sure to know the advantages and disadvantages on health insurance plan.

See Also: How To Port Health Insurance Policy?

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