![]() In a co-insurance contract, both the insurer and insured enter into an agreement where each party agrees to pay a fixed percentage of the medical bill. In India, the terms copay insurance and co-insurance are used interchangeably. Ensure that you compare a policy with a co-pay with other general health insurance policies and see how the premiums vary. Premiums: Most policies with a co-pay clause will have lower premiums.For example, if the insured individual incurs a medical bill of INR 50,000 and the co-payment clause is 10%, then the insured is expected to pay INR 5,000 while the insurance company will pay the remaining balance of INR 45,000. Copay percentage: This will be the percentage of the cost that the policyholder will have to bear.Here are some of the factors that you must consider when you go for a policy with copay: How to Select a Health Policy with Copay? A 10% copay clause means that the company is directly saving 10% of all payments. Mitigates the risk for insurance companies, as these companies operate on huge profits and losses. ![]() Discourages people from seeking treatment from more expensive hospitals as they will also have to be a bearer of the expensive hospital bill.Paying a portion of the treatment means that users will be aware of the expenses they will also incur, thus bringing about a sense of ownership.which could technically be charged from the insurer. Policyholders have to pay a portion of the fee they are naturally discouraged to make claims for treatments over a common issues such as cough and cold, gastric distress, etc.Putting in copay clauses in policies not only helps health insurance companies save a portion of expenses but also gives the company certain advantages as outlined below. The remainder of the amount will be paid by the insurance company. Thus, a copay in health insurance is an arrangement made with the health insurance company, in which the insured will need to pay a part of the medical expenses on their own. Rs.15000 as a copayment and the rest 90% will be paid by the insurer. In this case, she has to bear 10% of 1.5 lakh i.e. She has the approved claim of Rs.1.5 lakh. Nidima bought a health insurance policy and agreed to a copayment of 10%. The copay clause, along with the percentage, is always mentioned in the insurance policy and applies to medical services. Therefore, you can say that it is an admissible claim amount that both the insurer and insured pay on a sharing basis according to the respective percentages. However, the rest of the amount will be paid by the insurer. In simple words, the copay in health insurance is the percentage of the claim amount that is borne by an insured person under a health insurance policy. ![]() So, if you are a new entrant in health insurance don’t let copayment confuse you. Most health insurance providers offer health insurance with a copay clause. Thus, to curtail claims fraud, copayment came into existence. It’s not only affecting the insurance sector but also impacting innocent customers. According to the study conducted by EY (consultancy firm) on financial crime in India, there is a rise of 30% in insurance fraud since 2018 which is alarming. Fraudulent claims cost lots of money to the health insurance sector each year.
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