From Financialexpress · Saikat Neogi · · 1m 20s
Mandatory Co-Pay Could Raise Costs for Policyholders
Health insurance co-pay changes may increase out-of-pocket expenses for patients.
In brief
Health insurance co-pay changes may increase out-of-pocket expenses for patients. The General Insurance Council plans a 10% mandatory co-pay for retail health insurance, capping patient contributions at Rs 5 lakh per claim, potentially raising costs for policyholders with large hospitalization claims. Originally…
Mandatory Co-Pay Proposal
The General Insurance Council reportedly considers a 10% mandatory co-pay for retail health insurance plans, with patient contributions capped at Rs 5 lakh per claim.
Co-Pay Mechanism Explained
Under a voluntary co-payment arrangement, policyholders bear a specified percentage of inpatient hospitalisation costs, ranging between 5% and 20%.
Co-Pay Benefits and Risks
Co-pays benefit those with low claim frequency and stable health but may lead to higher out-of-pocket expenses during major hospitalizations.
Mandatory Co-Pay Impact
The mandatory co-pay cannot be waived or reduced and applies to all retail indemnity products, regardless of cashless or reimbursement procedures.
Senior Citizens' Challenges
Senior citizens with high hospitalization claims may face significant out-of-pocket costs under mandatory co-pays, especially with pre-existing conditions.
Zone-Based Co-Pay System
Health insurers classify locations into metro and non-metro zones, with premiums adjusted based on healthcare costs in different regions.
Deductible vs. Co-Pay
Deductibles require policyholders to pay a set amount before insurance coverage kicks in, while co-pays are a percentage of the claim.
The short version
The General Insurance Council plans a 10% mandatory co-pay for retail health insurance, capping patient contributions at Rs 5 lakh per claim, potentially raising costs for policyholders with large hospitalization claims.
