Important things to know about Co-pay in health insurance

Important things to know about Co-pay in health insurance

Having health insurance has become a necessity for almost every person. Many people have understood the importance of this, soon after the pandemic hit the globe. Many companies are coming up with different types of health insurance policies with different facilities. A health insurance policy is something that can be used in a medical emergency. In this, the insurance company will pay the major amount of medical expenses of the person which is a great thing and the reimaging amount will be borne by the policy owner.Nowadays there are so many plans that also provide family health insurance. There are health insurance plans that come with a co-pay clause. 

Actually, this is a clause where the person who is the policy owner agrees to pay some part of the health insurance from their pocket, and the rest will be paid by the insurance company. Many health insurance companies are considering this clause in their policies so that things are made clear to the person at the starting of the insurance agreement.

For example: If the person takes up an insurance policy that has a co-pay clause of 10%. If the person faces the medical expenditure of Rs. 1 lakh. So in this, the policy owner needs to pay 10% of Rs. 1 lakh. This will come out to be Rs. 10,000 and rest Rs. 90,000 will be paid by the health insurance company.

There are different features of Co-pay health insurance. Let’s have a look at them.

  • In this type of health insurance in which certain amount of medical expenditure is borne by the insured person and a major portion will be paid by the insurer.
  • The portion that needs to be paid by the insured person, is clearly stated in the agreement.
  • In this type of medical insurance policy, the term “Co-Insurance” is mentioned.
  • If the co-insurance will be large, so the co-pay of the insured person will also be large but the premium for the policy will be below.
  • This clause mostly comes to the insurance policy of senior citizens in India.
  • This is the clause mostly known by the people in established cities and is commonly used by them.

There might be many people that use the terms Co-pay and Co-insurance interchangeably. But actually, there is a difference between these two terms. In the co-insurance, the insurer and the insured person will enter into the insurance agreement where both the parties will agree to pay a certain percentage of the total medical expense. The ratio of payment can be 90:10, 80:20, 70:30, according to the mutual decisions of both parties. There is a written agreement between the two parties to make things very clear right in the beginning. On the other hand, Co-pay is the fixed amount paid for almost all types of medical services. This is the reason many people in India use these terms interchangeably but the only difference is the portion of the medical insurance paid by both parties.

Here is the list of the advantages of the Co-pay clause in health insurance. Let’s have a look at them.

  • This clause in the health insurance policy will not let any of the insured people make unnecessary claims to pay a portion of the medical expenses. Some people will come up with claims of flu, viral, or any gastric distress which are required to be paid by the insured person. But with some paperwork of Co-pay, the fake claims can be stopped. Both the parterres have written agreement and according to that, they will work.
  • Many a time it is seen that after getting the health insurance policy, some people start to get their expensive medical treatments. This used to bring a lot of pressure on the insurance policy to recover back all the medical expenses. But if the health insurance policy is having a Co-pay clause. It has stopped people from using health insurance policies for unnecessary things. This way the insured person will make the most genuine medical expenses.
  • This clause in the insurance policy will encourage the people to be honest enough with the policy. In this certain portion of the medical expenses is paid by the person. There is no chance of making unnecessary expenses that are of no use. This way the person will use the policy when it is required.

So Co-pay clause is a win-win situation for both parties. There is no sort of miscommunication between any of the party and things are made clear right in the beginning. Even Care Health Insurance comes up with this clause in their insurance policies. All the things are made clear by the company. You can easily visit the website and get to know more about the clause and even ask the team of experts to guide you in the best possible way. All the things will be done on the internet which is extremely convenient for every person.