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A Comprehensive Guide to Out of Pocket Costs in Health Insurance

If you have a health insurance plan, your insurance company will pay/reimburse the cost of your hospitalization. However, there are some things they won’t pay for. These costs called out of pocket costs in health insurance are things that you will have to pay for and may seem small at first. However, if you aren’t careful, they can really add up and cost you. 

Out of pocket costs in health insurance may include deductibles, copays, admission charges, non-admissible medical expenses and some portion of the room rent. The amount you will have to pay depends on the terms and conditions of your  health insurance plan, so be sure to read them carefully. The same applies to those on employee healthcare plans, read the policy documents carefully if you don’t want to be surprised by the bill.  

India’s insurance regulator the IRDAI has introduced regulations that help reduce the out of pocket costs in health insurance. These regulations apply to a term called ‘proportionate deductions’, which you can read more about in our blog about room rent limits. Despite these regulations, it is still very easy to incur extra expenses during hospitalization.  

Here’s a look at some of the out of pocket costs in health insurance you will face, and how to ensure you don’t pay too much.  

Out of Pocket Costs in Health Insurance 

In any health insurance policy, there are certain costs that your insurance provider will not pay for, no matter how high your premium. That applies to both personal plans and group health insurance plans. These costs are due to deductibles and copays in your health insurance plan. Deductible means the amount of money you agree to pay, before your policy can be claimed.   

Copays are a fixed amount you pay for a medical examination or procedure. If your policy has a copay, you will usually have to pay a certain amount from the total bill, like ₹1,000 or ₹5,000. The rest will be covered by your insurer. The copay amount varies from policy to policy. Some policies do not have a copay at all. That is a good way to ensure that you pay as little as possible for your bills.  

Other costs that you will have to pay include room rents if you opt for a higher value room. Medication, consultation fees, nursing charges, admission charges, processing fees, and non-admissible expenses are also not covered by health insurance policies, so you will have to pay for those.  

Out of pocket costs

Reducing Out of Pocket Costs in Health Insurance

You cannot completely avoid these additional costs, no matter what insurance plan you pick. However, there are some ways you can reduce the amount you pay. Here are some useful tips on reducing out of pocket costs in health insurance: 

  • Location: If you buy a policy in a Tier 3 city, you could find copays apply to treatments in Tier 2 or Tier 1 cities. Ensure that your health insurance policy covers treatment across India, irrespective of the location. 
  • Read the Terms and Conditions: When picking a healthcare plan, read the terms and conditions carefully. See if there are any deductibles or copays. Also, check the sub-limits of specific treatments. The greater the limit, the less you will have to pay out of pocket.  
  • Check Prior To Treatment: Even if you have read the conditions, it is always a good idea to check with your insurer prior to getting a planned procedure. Ensure that the hospital you are getting admitted to is part of the network and that the process is eligible for insurance. That way, you can make an informed decision without any surprising cost additions. 
  • Other Ways to Save: A large portion of the costs you will have to pay for are doctor consultations and medicines if you visit the OPD. That’s why you should pick a plan that offers discounts on these, giving you more ways to save.  

Why Onsurity is a Better Option 

If you are a small business or startup, you should consider getting employee healthcare benefits from Onsurity. Onsurity’s affordable employee healthcare plans offer a wide range of healthcare benefits. From doctor teleconsultations to discounts on medicine orders and health check-ups, your wellness membership for employees gives your team more for less.   

With our memberships, we also provide a group health insurance plan through our partner insurer without any deductibles or copays. That means if your employee gets admitted, our insurance partner will pay for the whole cost of their treatment (terms and conditions apply).  

That’s not all, we have also got a Good Doctors Team to help your employees with their hospitalization and claims. The team is a concierge service that helps employees understand all the little details. From whether a treatment is covered, to the possible out of pocket expenses they will have, Good Doctors know everything about your group health insurance plan with Onsurity’s wellness membership. The team can also advice employees on things like proportionate deductions, so that they make an informed choice about their hospitalization. 

Onsurity’s comprehensive affordable employee healthcare plans are the best ways to reduce your, and your employee’s healthcare costs. Our economical and flexible plans are ideal for SMEs and startups of all sizes. Get a healthcare membership with Onsurity today.