Answer Book question
On every admissible claim, you pay 20 percent and the insurer pays 80 percent. On a ₹10 lakh eligible bill, that is ₹2 lakh from you before any other deduction. Co-pay is common on senior plans and on some policies for people who join after 60.
On every admissible claim, you pay 20 percent and the insurer pays 80 percent. On a ₹10 lakh eligible bill, that is ₹2 lakh from you before any other deduction. Co-pay is common on senior plans and on some policies for people who join after 60.
A ₹10 lakh bill for a 72-year-old, policy sum insured ₹10 lakh, 20 percent co-pay. Even if every rupee is admissible, the insurer pays ₹8 lakh and the family pays ₹2 lakh. Add non-payables and a room deduction and the family's share is nearer ₹3 lakh.
Co-pay is a risk-sharing clause. It reduces premium and discourages small claims. It is usually mandatory on senior-entry plans and optional (for a premium discount) on others. Some policies apply it only to specific hospitals or zones.
Co-pay percentage and whether it applies to all claims Whether it is waivable at renewal or by paying more Whether it applies on top of sub-limits Whether a super top-up would also carry co-pay
Co-pay is applied to the admissible amount, after non-payables and room deductions. so it compounds with them. People add up the numbers and are shocked the insurer paid 60 percent.
Senior plans sold widely in Kerala typically carry 10–30 percent co-pay. Families should budget the co-pay share in a medical reserve.
Admissible ₹9 lakh after deductions; 20% co-pay = ₹1.8 lakh from family; insurer ₹7.2 lakh.
Accepting a voluntary co-pay for a premium discount can be sensible if you have savings and want a lower premium. For people without a reserve, avoid it.
Read the co-pay clause Calculate your share on a realistic ₹10 lakh bill Hold that amount in an accessible reserve
Is ₹5 lakh health insurance enough for my parents? Why did insurance pay only part of my hospital bill?
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