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All About Co-Payment In Health Insurance Plans

Published On Sep 04, 2022 10:00 AM By InsuranceDekho

The term "co-payment" in the context of health insurance refers to the portion of the claim amount that the policyholder is expected to cover out of pocket, with the insurance company covering the balance. Many insurance providers offer health insurance plans with co-payment requirements, while others allow for a voluntary co-payment. Health insurance with a voluntary co-pay is an option that policy owners can purchase and enjoy a lower price for.

All About Co-Payment In Health Insurance Plans

Co-Pay Health Insurance Features

Below we have enlisted some key features of co-pay health insurance

  • It is a sum paid (or a portion of the total) for specific medical procedures and prescription drugs while the patient is undergoing treatment.
  • A portion of the cost is covered by the insured, and the insurer covers the remainder of it.
  • By definition, it is a unique set price that is determined by the kind of medical care that is rendered.

What Distinguishes Co-Pay From Co-Insurance?

The terms "co-pay" and "co-insurance" are interchangeable. However, here in India, it has the same meaning. Higher co-insurance and co-pay ratios in favour of the insurer lead to lower rates for the insured.

But, what distinguishes co-pay from co-insurance? Co-insurance and co-pays differ primarily in that both the insurer and the insured agree to contribute a share of the overall cost with co-insurance. 

The co-insurance percentage may be expressed as 90-10, 70-30, 80-20, etc., with the insurer's share appearing first and the insured person's contribution following, depending on the terms of the agreement. 

A co-pay is a predetermined cost that is incurred for a number of medical procedures. These phrases allude to the pooling of risk and liability in India and are used interchangeably by all significant insurers.

Disadvantages of Co-pay In Health Insurance

Not all Indian insurers decide to include a co-pay provision in the insurance contract they provide you. This is due to a variety of factors that favour both the insurer and the insured, including:

  1. The insured person may be deterred from receiving critical medical care if the co-pay is excessively expensive, making the insurance policy completely useless. A person who has a large co-pay is virtually uninsured because the entire objective of the insurance policy is defeated. Many people who already find it difficult to pay for basic healthcare will be at a serious disadvantage and will be paying premiums for no reason at all if they are unable to receive enough financial aid from the insurer when they are in need.
  2. Co-pay medical insurance plans and products are typically less well-liked and less likely to be purchased. An individual who is aware of co-pay and co-insurance would select a coverage without these provisions. Simply because of this, an insurance that offers to cover all medical costs will have better goods and more customers.
  3. Lower premium is the outcome of a higher co-pay. This is accurate, but only to the degree that you, the insured, are exempt from using the cash value of your insurance policy. But if something does occur, you'll still need to use the money you saved on premiums to cover the cost of any necessary medical care. 


A co-pay policy may allow you to save money if you are in good physical and mental health, have no history of serious illnesses or diseases, and are not at risk for developing them in the future. You can take use of the many benefits that come with the coverage without having to cash in the full policy.

Also Read: 

How To Select The Best Health Insurance Plans?

All You Need to Know About Health Insurance Premium Calculator


This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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