Health Insurance: Do you know that there are some health insurance such that, despite having cashless facility in all the medical networks, some part of the expenditure has to be paid to the insured. Often, the reasons behind deduction in mediclaim include non-mediclaim expenses, investigation charges, hospital room rent, etc. Apart from this, due to different sub-limit clauses and capping, the insured has to bear the expenses despite going cashless. Most insurance companies sell policies with this clause. But many new insurers are not familiar with these rules.
What is co-pay clause?
The co-pay clause in an insurance policy means that the insured has to pay some share of the total cost of treatment.
Due to this, insurance companies sell the policies at a lower price because these expenses go into the account of the insured. This is an acceptable claim amount, which has to be paid by both the insurance company and the insured as an agreed proportion.
In insurance policies, the co-pay clause for medical services is written in the document as a percentage.
According to Shweta Jain, financial planner and founder of Investography, “Co-pay leads to lower premiums for insurers.
This is a fixed amount, which the insured has to pay at the time of claim. It also encourages people to be honest about their claims and not get unnecessary treatment.
This may also harm the policyholder as it may lead to a decision not to undergo treatment.”
In what ratio is the co-pay?
If you make a policy and there is an option of co-pay, then it means that you will pay some part of the cost of treatment out of your pocket while the remaining part will be given by the insurance company. The limit for this payment can range from 5 percent to 30 percent of the total sum assured.
For example, if the sum assured of your health policy is Rs 1 lakh along with 20% co-pay, then you will have to pay Rs 20,000 out of your pocket. While the remaining 80 thousand rupees of the claim will be paid by the insurance company.
Remember that you will have to pay 20% of the total claim for the treatment. Suppose if your medical bill has come to one lakh rupees in which some important tests and scans are of 10 thousand rupees. So the cost of test and scan will not be included in the total claim.
This means that your final claim amount is 90 thousand rupees, then according to co-pay, you will have to bear the burden of 20 percent of it. This means that the insurance company will pay 72 thousand rupees for the treatment and you will have to pay 18 thousand rupees.
Benefit of Co-pay to the insured?
Health insurance policies are becoming expensive with time. It is generally believed that for a better policy, you will have to pay a higher premium. But the insured can avail a discount on this premium if he opts for co-pay.
On opting for the co-pay clause option, the insurance company offers you a policy at a lower premium. According to Jain, “If someone is young and does not have any medical history, then he can take advantage of this low-premium and high cover scheme. ,
what should be done?
Now you must have understood that co-pay means that you have to bear the cost of treatment in a certain proportion during the claim settlement.
But before taking it, think carefully and choose co-pay health insurance based on your financial capabilities. This suggestion is because sometimes the cost of treatment of disease suddenly comes in front of us as an emergency.
If you have to bear the cost of treatment even if you have an insurance policy, then it can prove to be difficult during adverse circumstances.
Therefore, while pursuing your future goals, sign the policy documents to read and understand all the clauses of sub limits and co-pays.