Friends, if you have health insurance or are thinking of getting one, you must have heard of one thing – co-payment! Many people get confused by it and are shocked by the hospital bill. Today, I will explain in very simple terms what co-payment is, how it works, and what are the ways to avoid it. Let’s get started!
What Exactly is Co-Payment?
Simply put – the hospital bill came for ₹1 lakh. The insurance company will say, “We will pay ₹80,000, you pay the remaining ₹20,000 yourself.” This ₹20,000 you’re paying is called a co-payment. This means you’ll pay a certain percentage of the claim yourself, and the company will pay the rest.
This percentage is decided at the time of policy purchase. For example:
- 10% co-payment
- 20% co-payment
- Sometimes even 30%
Why Do Companies Include These Clauses?
The company thinks:
- If people cover some of the expenses themselves, they won’t be admitted to the hospital unnecessarily.
- The premium can be kept low (policies with co-payments are cheaper).
Explain This with an Example
Suppose your father had a knee operation, and the bill came to ₹5 lakh.
If the policy has a 20% co-payment, then:
- You pay = ₹1 lakh
- Company pay = ₹4 lakh
Yes, that’s a big difference!
It’s More Expensive for Senior Citizens
Policies for people over 60–65 years old often include a 20–30% co-payment because the company considers their risk exposure higher. Therefore, policies for senior citizens tend to be slightly more expensive or have a co-payment.
How Can You Reduce Your Co-Payment?
Get a Policy with a Zero Co-Payment
You’ll pay a slightly higher premium, but you’ll get full claim coverage.
Purchase an Add-on Rider
In many companies, you can remove the co-payment clause by paying an extra premium of ₹1,000–3,000.
If You’re Young, Accept the Co-Payment
If you’re 25–35 years old and healthy, you can save on premiums by purchasing a policy with a 10–20% co-payment.
Be Careful When Choosing a Hospital
In some policies, the co-payment is waived if you are admitted to a company-network hospital.
| Specification | Details |
|---|---|
| Co-payment clause | Common %: 10%, 20%, 30% |
| Senior citizens | Often charged 20–30% |
| Impact on premium | Co-payment policies are cheaper |
| How to withdraw | By opting for a zero co-payment add-on |
Pros and Cons
Pros:
- Premiums are lower
- Benefits for young and healthy individuals
- Easily obtainable
Cons:
- A large claim can result in significant out-of-pocket costs
- Can be costly for senior citizens
- Have to calculate how much to pay each time
Conclusion
Co-payment is a kind of “share the bill” rule. If your budget is tight and you’re young, you can buy a policy with a 10–20% co-payment – premium savings. But if you have senior citizens in your family or don’t want to take big risks, a zero-co-payment policy is best.
Eliminate tension by paying a slightly higher premium! Be sure to check the co-payment clause before purchasing the policy, otherwise, you’ll be in tears upon returning home from the hospital.
Let me know in the comments which one you’d prefer – co-payment or zero?
