Role of Deductible and Co-Pay in Health Insurance Policies

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When people have health insurance, there is a tendency for them to avail of more services and benefits out of their policy. To restrain this behaviour, Insurance companies brings in two tools, namely, Deductibles and Co-Pay.

What is Deductible?

It is the amount below which the Insurer will not pay for healthcare.

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Types of Deductible:

There are two types of Deductible: (i) Straight Deductible (ii) Percentage Deductible

  1. Straight Deductible: It is most commonly used in health insurance. It is expressed as a specific amount and applies for each claim under the policy.
  2. Percentage Deductible: The Percentage Deductible is another option. This is based either on a percentage of the sum insured or the total amount of the claim.

Deductibles helps to reduce losses and costs and even more importantly when the insured takes a share in each loss, it reduces morale and moral hazard, while encouraging loss control efforts by the insurance companies.

What is Co-Pay?

It provides that the Policyholder will bear a specified percentage of the Admissible claims amount. A co-payment does not reduce the Sum Insured. These are intended to ensure that the insured is made to share the healthcare costs incurred by them with the insurance companies. It discourages people from making unnecessary claims as they have to pay a portion of the expenses. Co pay discourages the misuse of treatment in expensive Hospitals under health insurance policies. Generally, the Insurance Companies apply Co-pay on:

  1. Senior Citizen related Policies.
  2. Reimbursement or Cashless claims in Non-Network Hospitals.
  3. Major Diseases.
  4. Area of Operation of the Insured (Zone Wise).
Also Read:  IRDA Regulations 2020: Protection of Policyholders interest by IRDA

One must therefore consider the present and past medical condition, and physical state, before deciding to take or not to take co-pay health insurance policy.

Get Resolutions for Insurance Complaints

If you are facing any difficulty with regards to Health Insurance related to delay in claim process, claim rejection, difference arising out of Co-Pay Health Insurance options etc., you can contact us at Insurance Samadhan. We are always there to help! At InsuranceSamadhan.com, we have helped resolve over 12,600 customer grievance cases in the past related to all types of Insurances, ULIPs and other financial products.

To reach us at InsuranceSamadhan.com –

Call us at – 844 844 0626

Mail us at – corporate@insurancesamadhan.com

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Virendra Suri

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