{"id":558,"date":"2019-05-13T04:55:18","date_gmt":"2019-05-13T04:55:18","guid":{"rendered":"http:\/\/blog.insurancesamadhan.com\/?p=558"},"modified":"2020-10-06T05:06:20","modified_gmt":"2020-10-06T05:06:20","slug":"what-is-co-pay-in-health-insurance","status":"publish","type":"post","link":"http:\/\/www.insurancesamadhan.com\/blog\/what-is-co-pay-in-health-insurance\/","title":{"rendered":"What is Co-pay in Health Insurance?"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_76 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-is-co-pay-in-health-insurance\/#Co-Pay_clause_under_Family_Floater_health_policy\" >Co-Pay clause under Family Floater health policy:<\/a><\/li><\/ul><\/nav><\/div>\n\n<p>A percentage of the claim amount, which is to be borne by the insured out of his\/her pocket, as per the insurance policy, is termed as Co-pay. For health policy, it may range from 10% to 20%.<\/p>\n\n\n\n<p><strong>Co-pay for health policies can be on account of the following:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>A general Co-pay:<\/strong>\u00a0Sharing by the insured, a percentage on all medical bills, regardless of the ailment\/illness, treatment is taken or the person treated.<\/li><li><strong>Co-pay for parents:<\/strong>\u00a0Sharing by the insured, a percentage of the claim amount for senior citizen parents insured under family floaters health insurance scheme.<\/li><li><strong>Co-pay only for Reimbursement Claims<\/strong>:\u00a0Sharing by the insured a percentage of bills submitted for reimbursement against OPD or daycare charges only. In such cases, the bills submitted for direct cashless treatments will be processed without any co-pay deduction.<\/li><\/ul>\n\n\n\n<p><center><a href=\"https:\/\/www.insurancesamadhan.com\/register?utm_source=google&#038;utm_medium=organic&#038;utm_campaign=blog_banner&#038;utm_content=http%3A%2F%2Fbit.ly%2F2kuc159\"\/><img decoding=\"async\" src=\"https:\/\/www.insurancesamadhan.com\/assets\/img\/contact.png\" alt=\"Get Resolutions for Insurance Complaints\"\/><\/a><\/center><\/p>\n\n\n\n<p>Co-pay only in case of admissible claims, arising out of admission in Non-Network Hospitals: Similar to the reimbursement claim, but applicable in case you happen to be admitted to a non-network hospital subject to the terms of the policy.<\/p>\n\n\n\n<p>It is important to understand the reason why insurers apply the co-pay clause. Some of them are listed below:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>To discourage filing unnecessary or insignificant claim amounts by the insured<\/li><li>To prevent the filing of fraudulent claims<\/li><li>To encourage sensible use of insurance<\/li><\/ol>\n\n\n\n<p><strong>Is it possible to purchase a health Insurance policy without Co-Pay?<\/strong><\/p>\n\n\n\n<p>Yes, you can buy health insurance policies without co-pay or voluntary deductible clauses at a substantially high premium. This, however, will depend on the type of policy to be purchased.<\/p>\n\n\n\n<p>To get clarity on how a Co-Payment Clause works,&nbsp;<strong>some examples<\/strong>&nbsp;are given here:<\/p>\n\n\n\n<p><strong>Co-pay of 10%:<\/strong>\u00a0Mr. X, a senior citizen, who has bought a health insurance policy with a co-pay clause of 10%, goes for bi-annual health a check-up at a reputed hospital. At his age, he maintains good health.<\/p>\n\n\n\n<p>During one of such routine check-up, Mr X was advised to undergo a small treatment\/procedure covered under the policy. The cost of such treatment\/procedure being INR. 15,000.00 , he would have to pay INR 1500.00 on his account and the balance INR 13,500.00 the insurance company would pay.<\/p>\n\n\n\n<p><strong>Zero Co-Pay:\u00a0<\/strong>Mr. Y, son of Mr. A, is working with a corporate and is covered by a group health policy bought by the employer, with a zero co-payment clause; i.e. the employees do not have to pay any money out of their pocket for the medical expenses covered under the policy.<\/p>\n\n\n\n<p>Mr. Y had to be hospitalized, for an illness covered by the group policy, in a network hospital listed with the insurance company\/Third Party Administrator (TPA) under the cashless treatment scheme and only incurred a cost of INR. 1100 for two days hospitalization, towards the travel and other expenses of caretaker which was not admissible under the policy. The medical bills were paid by the insurance company directly to the network hospital.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Co-Pay_clause_under_Family_Floater_health_policy\"><\/span><strong>Co-Pay clause under Family Floater health policy:<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Mr. &amp; Mrs. Z have bought a family floater policy covering their parents, after realizing that the previous senior citizen policy had a very high co-pay of 30% and had a loading of an additional 25% on the premiums. Which meant that for a claim of INR 20,000.00, their parents had to pay INR 6000.00 from their own pocket with an additional premium increase of 25% for the next year\u2019s policy renewal as loading.<\/p>\n\n\n\n<p>Thus increasing the cost of the policy with each claim, and the parents would also have to pay a large amount out of their own pocket for every bill.<\/p>\n\n\n\n<p>Family floater policy with a lower co-pay clause (10%) and loading (5%), allowed the family to cover the expenses and keep the premiums within limits in case of a claim during the year.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A percentage of the claim amount, which is to be borne by the insured out of his\/her pocket, as per the insurance policy, is termed as Co-pay. For health policy, it may range from 10% to 20%. Co-pay for health&hellip; <a href=\"http:\/\/www.insurancesamadhan.com\/blog\/what-is-co-pay-in-health-insurance\/\" class=\"more-link\">Continue Reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":564,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-558","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>All you need to know about Co-pay in Health Insurance Policy<\/title>\n<meta name=\"description\" content=\"Co-pay is an important term in Health Insurance which define the amount of money paid by the owner itself and rest is issued by the the company.\" \/>\n<meta name=\"robots\" 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For health policy, it may range from 10% to 20%. 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