Some insurance companies offer you the option to voluntarily opt for the copay clause with your health insurance policy and as a result, reduce your premium amount. For instance, Care Insurance in its Care Plan has made copayment of 20% mandatory for health insurance policies bought for people who enter the policy at 61 years or more. There are 3 main types of copayment in health insurance - 1️⃣ Mandatory CopaymentĪ few health insurance policies, especially those for senior citizens, come with a mandatory copayment clause. And, the insurance company will pay the remaining amount of INR 4,27,500. Out of this, Rohit will have to pay INR 47,500 out of his pocket (10% of 4,75,000). There were deductions on non-medical items worth INR 25,000.His hospital bill amounts to INR 5 lakhs.He undergoes hospitalisation for heart surgery and. His policy has a copayment clause of 10%. The rest will be paid by the insurer.įor instance, Rohit buys a health insurance policy with a sum insured of INR 10 Lakhs. So, let's begin! What Is Copay In Health Insurance? How Does It Work?Ĭopay is essentially a predetermined % of your approved claim amount that you'll have to bear yourself. In this article, we discuss the copay clause in health insurance - how it works, its types, and more. Some of these cappings and clauses include the room-rent limit, disease-wise capping, copayment clause, and so on. Most policies come with cappings and clauses that limit the amount you claim - and you get back only a part of the claim amount even though your hospital bills are within your base sum insured. Health insurance, however, doesn’t work like that. For instance, say you choose a sum insured of INR 5 Lakhs thinking if ever you undergo an expensive surgery and the hospital bill amounts to INR 5 Lakhs, it will help you cover the entire bill. You buy a health insurance policy with the thought that it will offer you financial protection if you undergo hospitalisation in the future.
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