What is Copay in Health Insurance Policies?

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Updated on Nov 29, 2022

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One thing that’s out of our league is “what will happen tomorrow?” To save yourself from financial crippling due to sudden healthcare emergencies, insurance is what you need. However, it is essential to understand all the clauses and terms while you are planning for it. A copay may look like a common insurance term, but there are many who do not fully understand it

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What is copayment Health Insurance? What are its features? 

In a health insurance policy, the copay is a clause added by the company in their policy terms. In layman’s language, the copay is the percentage of the amount that an insured person will pay as a part of the claim of the insurance. If you agree to copay 10% of the claim, this means that in case you make a claim the company will pay 90% of the amount towards the medical expenses and 10% will be borne by you. 

It is quite obvious that the copay amount is inversely proportional to the premium that an insured person pays. The higher the copay, the lower the premium you have to pay. There are several features of this term, like-

  • With copay, you need not carry a heavy load. There’s only a small proportion like 10-20% that you need to pay while the rest will be covered by your insurance company. 
  • Sometimes, the type of medical services you opt for also decides the amount of copayment.
  • Mostly it is the senior citizens who are inevitably levied with the copay amount.
  • The best out of copay comes in metro cities where the medical cost is relatively higher. 

How does copay work? 

It is quite easy to understand what is copay in health insurance and how it works! As aforementioned, it is the percentage of claims that as an insurer you will have to pay. For instance, suppose you agreed to 10% of the copay amount. In such a case, if your medical bill is INR 1 lakh, you will have to bear 10% of it, i.e. INR 10,000. The rest of the INR 90,000 will be paid by the company. 

Why do health insurance companies apply the co-pay clause?

After understanding what is copay in health insurance, one obvious question that may come to your mind is, why do the companies levy co-pay? Here’s the answer: 

  • With copay, the health insurance companies make sure that the claim amount is not being misused. If they have to pay 100%, insurers may go for higher medical costs unnecessarily, and that will have a negative impact on the company. 
  • As the insurer will also have to pay an amount of claim, say 10%, they will claim only in times of need and will go for reasonable medical treatments only. 
  • For the company, copay acts as a helping hand for them as some amount is paid by the insurer. 

What is co-insurance in health insurance

Are you wondering if copay and co-insurance are the same things? Well, to a great extent, they are the same. In copayment, the clause mentions a fixed percentage of the amount that the insurer has to pay. However, in co-insurance, the ratio of the amount is mentioned like 10:90, 20:80, 40:60, etc. whereas, in the case of copay, the numbers are taken to be a percentage.

What is deductible in health insurance

Another important term that you come across in health insurance is “deductible”. So, what is deductible in health insurance? While on one hand, the copay is the percentage of the claim for every medical claim, on the other hand, the deductible is the fixed amount that an insurer has to pay for every medical claim. For instance, if the deductible is INR 30,000, the insurance company will aid your medical finances if only your bill exceeds INR 30,000. This amount is fixed and does not change no matter what the billing amount is. 

Factors to keep in mind while opting for copay in health insurance

There are a few factors that every insurer must keep in mind before signing up for health insurance, like: 

  • Your priority must be to look for a company that does not have copay as a compulsory clause in their terms. 
  • If you have to decide a clause, make sure the amount you agree for is reasonable for you and you can afford it for every bill. 
  • Don’t miss out on the copay clause before signing. Make sure you take ample advice and go through every clause in order to have a complete understanding of your insurance plan. 

It is vital to always stick to a trusted company and know all the details of the insurance clauses, terms, and conditions before signing. As these days health insurance has become inevitable, it is important to have a plan that not only offers you maximum coverage but at the same time is not too heavy on your pocket. You, therefore, need to know your requirements and your budget before you decide on the copay amount. 

Also Read: What Is The Importance Of A Health Insurance Policy In Our Life?

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.

Sep 21, 2021
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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