How copay proves important in health cover?

Health cover is a critical financial need in the era of rising healthcare expenses, growing inflation and competitive lifestyle environment. However, as the cost of healthcare expenses growing so is the cost of healthcare insurance policies increasing steeply. To reduce the burden of insurance premium costs, insurance buyers can opt for the co-pay option. Many health insurance companies now come up with the co-pay options in their mediclaim policies. Co-pay is becoming increasing popular in group health insurance plan. Many individual plans are also being introduced for buyers with co-pay options.

The article discusses about copay option and its impact on your healthcare policy

Co-Pay

When you take a co-pay option the insurer agrees to pay a percentage of the health claim. This percentage could range anything between 10 to 25%. The insured must first pay his or her share of the claim and then the insurance company settles the balance amount up to the limit specified in the sum insured of the Mediclaim policy.

Benefits

When you opt for co-pay your medical insurance premium will be lower. If you opt for 20% co-pay, then your health insurance premium can be lower by up to 20%. The insured gains opting for co-pay when he or she has no hospitalization in the policy term. However, if there is a hospitalization then the insured has to pay his or her co-pay amount.

Some of the copayment policies are as follows:

Class of Service:

Some insurers charge higher co-pay fees if the insured person avails higher class of service. So when you opt for deluxe suite you may have to pay higher co-pay charges. This is where you class of service comes into picture.

Metropolitan hospitalization

Hospitalization costs in metropolitan cities are obviously higher compared to regular cities. While co-pay is not a compulsion in non-metro city, an insured undergoing hospitalization in a metro city needs to have to co-pay a portion of the claim.

Non-Network Hospital treatment

Some healthcare insurance policies demand for co-pay if the insured undergoes treatment in a non-network hospital. The insured should confirm this while selecting a hospital. Network of empanelled hospitals can change any time so it is advisable to call the health insurance company before hospitalization and confirm whether a particular hospital is empanelled with the insurer or not.

Pre-existing medical conditions

In most healthcare policies pre-existing medical conditions are excluded from the cover for the first 3 years or so. Thereafter the insured can claim for treatment of pre-existing conditions. But if you have copay option you can pay expenses of these illnesses as well.

Should you opt for co-pay?

When covered under a group healthcare insurance plan you’re bound by the co-pay contract between your company and the health insurer. On an individual front such as a separate mediclaim for your parents or family floater plans you will have to see the trade-off between co-payment for specific health issues and the cost of premium to make an informed decision. When young and healthy a co-pay option is surely going to save the cost on healthcare insurance premiums. Over a period of time this cost saving can be quite substantial.

Conclusion

Co-payment can help you reduce your health insurance premium costs to great extent. For this you should understand the pros and cons behind it while buying healthcare policy with co-pay clause. There is standard format for copay options in your policy document. It is advisable you should read the policy document very carefully to understand the different provisions of the co-payment clause.