Co-Payment
A fixed share of every admissible claim that the policyholder pays out of pocket.
Co-pay of 10% to 20% is common on senior-citizen and zone-based plans. It lowers the premium but applies to each claim for the life of the policy.
Why Co-Payment matters when comparing products
When comparing health insurance policies in India, understanding co-payment clauses is crucial. A co-payment feature means a portion of hospitalisation expenses will always be borne by the policyholder, impacting out-of-pocket costs. While it can lead to lower premiums, it's important to assess the potential financial burden during a claim, especially for frequent medical needs or higher-value treatments, to ensure the policy aligns with one's financial planning.
Illustrative example
Suppose a health insurance policy has a 10% co-payment clause. If the total admissible hospital bill amounts to ₹1,00,000, the policyholder would be required to pay ₹10,000 directly. The insurance company would then cover the remaining ₹90,000. This is paid by the policyholder for every admissible claim, regardless of the annual sum insured.