Health Insurance: What is co-payment? Why is its effect visible from premium to claim?


There are many terms and conditions in the policies issued by insurance companies that are very important to understand. Often people buy a policy only after seeing the premium and coverage. When they do not get the full claim due to a lack of knowledge of the terms and conditions, they complain that the insurance company deliberately does not pay the full amount. At the same time, the companies argue that at the time of giving the policy, they had mentioned all the terms and conditions in the policy documents. The customer did not see or understand him. Co-payment in health insurance is also one such condition, which greatly affects the policy premium as well as the claim.


Most policyholders have no idea about co-payment. They come to know about this only when they take the claim and the company pays less citing co-payment. Therefore, it is very important to know the co-payment thoroughly while taking a health insurance policy.

What is co-payment?
Co-payment is the part of the insurance claim that the policyholder himself has to pay. Usually, it ranges from 10 to 30 percent. Let us assume that the co-payment of the insurance policy you have taken is 30 percent. Now if you make a claim of Rs 200,000, the insurance company will give you only Rs 140,000. You will have to pay the remaining Rs 60,000 from your own pocket.

The special thing is that the rule of co-payment applies every time the policyholder makes a claim. Thus, co-payment in health insurance is an agreement between the policyholder and the insurer in which the policyholder agrees to pay a certain percentage of his medical bills on his own.

Co-payment is not a mandatory part of the policy
It is not necessary that every health insurance policy has the option of co-payment. This means you can get 100 percent of your claim. Many companies also offer health policies in which they are responsible for paying 100 percent of the claim.


The higher the co-payment, the lower will be the premium.
The premium of an insurance policy is determined by co-payment. The policy in which the share of co-payment is higher, its premium is lower. In this case, the insured has to pay more money from his own pocket for the treatment expenses. At the same time, if the co-payment is less in a policy then its premium is higher. But, the advantage of low co-payment is that the policyholder has to pay less out of pocket for the treatment expenses.

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