1 day ago
Mandatory Health Insurance Co-Pay Could Raise Policyholders’ Costs
A co-pay means a person pays part of a medical bill while their insurer pays the rest.
The General Insurance Council is reportedly considering making a 10% co-pay compulsory for retail health insurance.
The patient’s share would be capped at Rs 5 lakh per claim.
Insurers may want this rule to help control healthcare costs.
But people could have to pay more themselves when they are hospitalised.
This may be especially difficult for older people and those who need treatment often.
Some policies already use co-pays or charge more when treatment is in a higher-cost area.
A deductible is different: it is an amount the patient pays first, before insurance pays its share.
The General Insurance Council is reportedly considering a 10% mandatory co-pay for retail health insurance plans, capped at Rs 5 lakh per claim.
The proposed co-pay would apply to retail indemnity products for both cashless and reimbursement claims and could not be waived through add-ons.
Insurers may seek the measure to curb healthcare billing distortions, but policyholders would face additional out-of-pocket costs.
Senior citizens and people with chronic conditions or frequent claims could be especially affected by paying a share of every claim.
The article distinguishes co-pay, which is a percentage of admissible costs, from a deductible, a fixed amount paid before insurance coverage begins.
- Who
- The General Insurance Council is reportedly considering the proposal; retail health insurance policyholders would be affected.
- What
- A reported proposal for a mandatory 10% co-pay, with the policyholder’s contribution capped at Rs 5 lakh per claim.
- Where
- Retail health insurance plans in India.
- When
- Why
- Insurers may seek to curb distortions in healthcare bills and costs.
Rationale for mandatory co-pay
Concerns for policyholders
Healthcare costs
Rationale for mandatory co-pay
Insurers may use mandatory cost-sharing to curb distortions and rising healthcare bills.
Concerns for policyholders
Policyholders would pay part of covered costs even when they bought comprehensive, higher-value cover.
Financial impact
Rationale for mandatory co-pay
Voluntary co-pay can reduce premiums and may suit people with low claim frequency and enough savings.
Concerns for policyholders
A compulsory contribution could increase out-of-pocket spending, particularly for large claims and people who need frequent care.
Senior citizens
Rationale for mandatory co-pay
Existing co-pay arrangements can help make senior citizens’ premiums more affordable.
Concerns for policyholders
If co-pay becomes mandatory, older people and those with chronic conditions may face significant costs on each claim and possible disputes with insurers.
Key facts
- Reported proposal
- 10% mandatory co-pay for retail health insurance plans
- Claim contribution cap
- Rs 5 lakh per claim
- Claim types
- Would apply to cashless and reimbursement claims
- Waivers
- The proposed co-pay could not be waived, reduced or modified through riders or add-ons
- Voluntary co-pay range
- The article says voluntary co-pay commonly ranges from 5% to 20%
- Example of co-pay
- At 10% of an admissible Rs 5 lakh claim, the policyholder pays Rs 50,000
- Example of deductible
- With a Rs 1 lakh deductible and a Rs 5 lakh admissible claim, the insurer pays Rs 4 lakh
Sources
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