The insurance company will cover the rest. This is done using co-pay clauses.
You’ve bought a policy for health insurance and now it is time to start claiming. You visit the hospital and get checked up. After treatment, you are given a bill. Typically, the health insurance company will take care of the entire expense as per the terms of your policy, and you will walk out healthier, and just as rich as you were when you were admitted in the hospital. Co-pay is a different matter.
What is Health Insurance Copay?
A co-pay clause in your insurance policy will require you to cover a portion of the medical expenses out of your pocket and the insurer will pay the remainder. Today, there are many insurance companies (e.g., United India Insurance Company or New India Insurance Company or SBI General Insurance). There are many insurance companies today (New India Insurance Company, United India Insurance Company, SBI General Insurance, etc.) that offer co-pay clauses. Co-pay amounts are usually a set amount for different services or drugs. They can vary depending on the type of treatment required.
Example: If your policy contains a 10% co-pay or co-insurance clause, and your total medical expenses exceed Rs.50,000 you will need to pay Rs.5,000 from your pocket. The insurer will then cover the Rs.45,000.
Co-Pay Health Insurance Features:
- It’s a payment (or a percentage) that is paid for certain medications and medical treatment.
- The insured pays a portion of the cost, while the insurer covers the rest.
- It is a fixed fee that is charged based on the type of medical service provided.
- This terminology can be used interchangeably with co-insurance. It is the same thing in India.
- Higher co-insurance and copay ratios in favor of the insurer means lower premiums for the insured.
- This is mainly applicable to seniors in India who have health insurance policies.
- In major cities, co-pay policies are more common.
What is the difference between Co-pay and Co-insurance?
The term co-pay for health insurance is often used interchangeably with the term co-insurance. The main difference between copay and coinsurance lies in the fact that co-insurance is an agreement between the insured and the insurer where each party agrees on a percentage of total costs. The co-insurance percentage can be represented by the following: 90-10, 70-30 and 80-20. Depending on the agreement, the co-insurance percentage is represented as the insurer’s contribution first and the insured’s second. The co-pay is the amount that you pay for health care services. All major Indian insurers use these terms interchangeably to refer to the sharing of risk or liability.
Why are co-pay clauses in insurance policies?
Insurance companies have co-pay clauses, which are not only advantageous for the company because it will be able save some money on claims but also provide the following benefits:
- People should be discouraged from filing unnecessary claims as they will be required to pay a portion. The insurer could charge back any claims for medication or treatment for the common cold. This reduces the amount of paperwork required and creates a lot more work for both sides. The co-pay is designed to discourage the misuse of insurance policies.
- This discourages people from going to expensive hospitals or healthcare centres. Consider that you have an insurance policy that has a 10% co-pay or co-insurance clause. The cost of treatment for a medical condition in a hospital can reach Rs.10,000. In this case, the insurer will pay Rs.9,000 while you will have to pay Rs.1,000. But if the medical treatment has been sought at an expensive hospital/institution, the total expense for the same treatment could be as high as Rs.40,000 (recent polls suggest that boutique hospitals, high-class medical centres and speciality centres charge up to 40% more for the same services and treatments). You will be required to pay Rs.4,000 from your own pocket. This will stop average insurance holders from spending more money at expensive hospitals.
- Encourages responsible and prudent use of your health insurance policies. Co-payment is a cost that you have to pay out of pocket for your medical treatment or hospitalization. You will feel proud of your co-payment and how you use it.
- Insurance companies can reduce the risk and liability. Insurance companies are large businesses that have huge profit and loss statements. Payments made to victims of claims increase the balance in their loss column. An insurance company can save 10% by including a co-pay clause (or coinsurance) in all of its policies.
What are the drawbacks of copay?
Some insurers in India may not add a copay clause to an insurance policy. There are many reasons for this, both from the insurer and the insured.
- The co-pay amount may be too high and discourage the insured from seeking vital medical care. This could render the insurance policy useless. The insurance policy’s purpose is lost if a person has to pay high co-pays. Many people who cannot afford basic healthcare would be in a major disadvantage. They will pay premiums for no reason if they don’t receive financial assistance from the insurer.
- Policies with co-pay and medical insurance policies are less popular and less likely to sell. If you are familiar with co-pay and coinsurance, you will choose a policy without such clauses. A policy that covers all medical expenses will result in better products and greater sales.
- Higher co-pay means less premium. This is true but it’s only good for you, the insured person. However, if anything happens, all the money you have saved on premiums will be used to pay for treatment costs.
Are you looking for a policy that includes co-pay in your health insurance?
Today’s health insurance policies are costly and do more than cover hospital bills. Premiums and policies can be used to reduce taxes and provide a safety net. In general, higher premiums are associated with better policies. This premium cost can be reduced if you choose an insurer that offers a copay policy.
A co-pay policy can be a great way to save money if you’re in good health. The co-pay policy does not require you to cash it out and you can still enjoy the many benefits that come with the policy.
A person might pay between 10% and 20% more if they have a copay clause on their health insurance policy. A co-pay clause is a requirement for any insurer. They will take all the risk and therefore charge higher premiums. National Insurance Co. Ltd. offers a copay scheme which provides a 10% discount on premium if you accept a 2% copay clause.
