For instance, if the treatment is availed at an expensive hospital, and the claim amount is Rs. The co-payment clause discourages people from availing themselves of treatments at expensive healthcare centres or hospitals as the insurers also need to pay a certain amount from their own pocket.
So, simply put, the co-payment clause discourages the insured from making unnecessary claims. This reduces the paperwork from both parties. This leads to a lesser number of claims, especially in the case of minor illnesses such as common cold, regular gastric distress, etc. People are discouraged from making unnecessary claims as they are required to pay a portion out of their own pockets, so they might refrain from making claims considering it will add to their expenses.Other reasons for the inclusion of the co-payment clause in health insurance plans are listed below: Many insurance companies offer health insurance plans with co-payment clauses as it helps them save a considerable amount at the time of claims. Why Is co-pay Clause Included in Policies? Co-payment is mostly popular in metropolitan cities where the treatment costs are higher in comparison to smaller towns and cities.co-pay clauses are implemented in the case of senior-citizen health insurance policies.If the insured opts for a lower co-payment amount, they need to pay a higher premium.The percentage of co-payment depends on the medical service availed.In the co-pay clause, a major portion of the claim is covered by the health insurance company while the insured has to take care of a specific percentage of the expense incurred.To have a better understanding of the co-payment clause in health insurance, read along with its features that include: What Are the Features of Co-Payment Clause? On the other hand, if the insured opts for a lower co-pay, the amount to be paid during the claim gets reduced but also requires the insured to pay a higher premium against the health insurance.Insurers who opt for a higher co-pay will be able to lower their total premium payment but will have to pay a greater amount during a claim.Talking about co-payment in both situations, it can be found that: On the contrary, in case of a reimbursement claim, the health insurance company reimburses the insured for the expenses incurred while undergoing treatment. In case of availing cashless medical treatment and filing the claim, the health insurance company settles the expenses incurred directly with the hospital where the insured or family members are undergoing treatment. 45,000.Īn insured individual can file a claim for health insurance either through cashless or reimbursement of the expenses. 5,000 from his/her own pocket and the insurance company will bear the remaining amount, that is Rs. Then if the claim request gets approved, the insured will be required to pay 10% of the amount, that is Rs.
For instance, a health insurance policy comes with a co-payment clause of 10% and a claim of Rs. The policy buyers can buy health insurance with voluntary co-pay and enjoy a reduced premium for that policy.Ĭo-payment clauses in health insurance policies are comparatively cheaper since they reduce the insurer's liability by sharing losses with both the insured and the insurer. There are many insurance companies offering health insurance plans with mandatory co-payment clauses, whereas others come with a voluntary co-payment option. Co-payment in health insurance refers to the percentage of the claim amount which the policyholder is required to pay from their end and the rest is borne by the insurance company in case of a health insurance claim.
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