Copay in Health Insurance

Digit Health Insurance with 0% Copayment option
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Copay Meaning & Definition in Health Insurance

What is Copay in Health Insurance

What are the Types of Copay Clauses in Health Insurance?

Now that we have learnt about what is copay in medical insurance, let us take a look at its types.

Not all health insurance policies come with mandatory copay clauses. But, if your health insurance policy has this clause, it can be applied in ways illustrated in the table below:

Type of Copay

Applicability

On Medical Bills

Under this category, the copay clause is applicable to all the claims raised, irrespective of whether it is voluntary or mandatory. You will thus need to pay a portion of the claim amount thus raised.

On Senior Citizen Policies

These are the policies that mostly come with mandatory copay clauses. This is mostly because the treatment expenses for senior citizens are usually much higher.

For Reimbursement claims & Treatment at any non-network Hospital

Sometimes, insurance providers only levy the copayment clause on reimbursement claims or during treatment at non-network hospitals. Under these circumstances, the cashless claims are borne by insurance providers.

For Hospitalisation in Metro Cities

Since treatment costs at metropolitan cities are higher than that of smaller cities and towns, insurance providers might levy a copay clause for such circumstances.

Features of Copay Health Insurance Policy

Why Insurance Companies levy Copay Clauses on Policyholder?

Advantages and Disadvantages brought by the Copay Clause

Advantages

Disadvantages

One of the biggest advantages when it comes to the copay clause is that it helps to lower the premium paid towards your insurance policy. Even if you have to pay a part of your claim for that, it can prove beneficial because it reduces your periodic expenditures by lowering your premium payment.

Insurance policies which demand a high copayment amount from policyholders can stop the insured person to seek proper healthcare during their time of need, and render the policy useless. Copayment puts the insured person at a disadvantage because they can’t avail adequate healthcare from insurance providers, without paying for a portion of the same.

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Even though higher copay means less premium, you will end up paying more towards your treatment expenses than you save on premiums.

That is why health insurance policies without copay clauses are much more popular than those which levy it.

FAQs about Copay in Health Insurance