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Copayment in Health Insurance: A Highly Effective Guide

Whether you are taking a health insurance policy for the first time, or renewing one, it is very important to read the terms and conditions. That’s is to avoid being caught by surprise, when you want to claim your insurance benefits. One term that can be confusing is copayment. Have you have ever asked yourself “what is copayment in health insurance?”

If so, that’s exactly what this blog explains. We have broken down the concept for you. We have also mentioned how copays apply under the group health insurance with your Onsurity Plus membership if you are subscribed to the healthcare plan (here’s a hint: they don’t).  

What Does Copayment in Insurance Mean?

In some health insurance policies, your insurance company will pay the full cost of your medical bills apart from the medically excluded items, list for which you can find in your health insurance policy. If you have copayment in health insurance clause, that is not the case. If there is a co-pay clause, you will have to pay a certain portion of the bills from your own pocket.  

Remember, this is only a part of the total insurance claimable bill, like 10% or 20%. Sometimes that cost is a percentage, and at other times it is a fixed amount. Your insurer will still pay for most of the cost, but there is a small portion that you must pay.  

Let us assume, for example, your hospitalization costs ₹50,000, and your health insurance policy has a copay clause of ₹5,000. In that case, you will have to pay ₹5,000 from your pocket, the remaining ₹45,000 will be paid by the insurer.  

If a policy has copay applicable then it applies to all costs covered by the insurer. That means you will still have to pay out of your pocket for other related costs like medication, out-patient department expenses and the like that are not covered by your health insurance policy.  

It is good to know that there is also a term called co-insurance, which is slightly different. Co-insurance refers to the percentage of treatment costs you must pay, after deductibles. Like the copay provision, it is often a small percentage like 10% or 20%.  Co-insurance can also refer to different insurers sharing the risk amongst themselves. That’s why it is wise to know the difference.

copayment in insurance example

Why Does Copayment in Insurance exist? 

If you are already paying a huge amount as premium for your insurance, you must be wondering why copays exist. There are three major reasons: 

  • Discourage unnecessary claims 
  • Discourage treatment at expensive hospitals 
  • Encourage honest use of policy 

In the end, it all comes down to finances. For insurance companies, even saving 10% per individual will add up to a lot over the year. It helps maintain their profitability, while ensuring that the right people get paid for the right expenses.  

A higher copayment in health insurance means your health insurance policy premium amount will be lower. This is great, if you can afford it. For most people though, a copayment in insurance clause may seem unfair. However, you must remember that it is added to protect you.  

The copay policy exists to stop people from claiming money for a treatment that wasn’t necessary or could be done cheaper. It exists to deter people from misusing their health insurance policies so that people who really need the money will get it.  

That not only saves the insurance company money, but also time and effort in checking the paperwork. That’s because with a copay clause, it is likely that only people who have a genuine claim will file the paperwork. Copayment in health insurance also exists to ensure people get the treatment they need and can afford. Without it, individuals will be likely to visit expensive private hospitals for treatment. Knowing that they would have to pay for a portion of that cost will discourage this. 

CoPayment with Your Onsurity Membership 

Your Onsurity HealthCare membership comes with a group health insurance plan, provided by our partner insurer. The group health insurance under our HealthCare membership does not have a copay clause. That means if you get hospitalized, the insurance company will pay for the full cost of your care, subject to T&C’s.  

Of course, as with all health insurance plans, some costs will not be borne by the company. Be sure to read the T&C’s policy document carefully. If you have any doubts, our Friendly Good Doctor Team is always there to help! 

The Onsurity advantage means you have peace of mind. In case of any unfortunate medical emergency, you don’t have to worry about your medical costs. Our partner insurer takes care of the costs, and we at Onsurity help you navigate the complex world of medical insurance through the Good Doctor Team

Onsurity provides employee healthcare benefits for startups and SMEs which also comes with group health insurance as one of the features. An Onsurity membership has access to a wide variety of healthcare benefits, from doctor teleconsultations to online medicine ordering and lab test booking. We have made Onsurity a platform everyone will love for their healthcare needs.  

Our affordable employee healthcare plans are ideal for MSMEs and startups of all sizes. By merging employee healthcare benefits with possibility of health insurance for startups, we have made Onsurity a platform for the digital age.  

To get started, simply head to our website and register. It takes only two minutes.