When Should You Opt for Copay in Health Insurance?

March 25, 2022April 28, 2022 Michael Caine

Copay health insurance schemes represent health insurance plans in which the holder of the health insurance scheme has to pay a part of the expenditure incurred for medical reasons (treatment, hospitalization, etc.). With copay, the health insurance policy holder pays part of the cost and the health insurance company pays a part too. Therefore, the payment of health costs is shared, and certain clauses and conditions are stipulated on policies such as these.

Copay Policies

It’s important to know about copay in health insurance in a little more detail. In a regular insurance policy or plan, one without a copay clause, your health insurance will typically pay for the entire cost of treatment according to the terms and conditions of your health insurance plan. You will be healthier and won’t have to experience any out-of-pocket expenses for medical treatment. However, with a copay condition, you sign a contract with the insurance company to share the expense of medical treatment.

Copay clauses exist in several leading insurance plans like those of New India Insurance, SBI General Insurance, etc. What is important to note about copay plans is that the amount representing the copay condition is predetermined for various services, medication, treatment, etc. For instance, this may be fixed according to a percentage of the total cost of treatment, medication, etc. Let’s say your policy contains a copay condition of 10%. If your entire medical bill amounts to Rs. 50,000, you only have to pay 10% of this, which works out to Rs. 5,000, the insurer paying the remainder, Rs. 45,000.

The Features of Copay Insurance

Once you know the features of a copay policy, you will automatically be able to gauge why it is a good plan for some individuals. Copay in health insurance has the following features:

Copay involves the coverage of only a part of the medical expenses incurred by individuals, the individuals themselves pay the rest.
In usual circumstances of a copay policy, the insurer covers the majority of the expense of medication, treatment, surgery, etc.
According to the Health medical services rendered, the amounts under a copay plan are fixed beforehand, in the terms of the copay policy.
Copay is opted for by individuals as premiums are lower for copay policies than for regular insurance policies. The higher the copay amount for the insured person is, the lower the insurance premium will be. Premium-wise, this works out more affordable for some individuals.
Copay policies are opted for, in the majority, by senior citizens (who may wish to pay lower premiums), and people with no pre-existing health conditions (individuals who are in relatively good health and are fit).
Copay health schemes discourage the misuse of claims through health insurance.
Copay clauses are normally included in healthcare plans that apply to metros in India.