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Copayment in Health Insurance

In health insurance, a copayment refers to the fixed percentage of total medical costs a person agrees to pay by themselves each time they file a health insurance claim. The insurance company agrees to pay the rest as long as the bills are within the coverage limit.

A copay applies each time you file a claim under your health insurance policy. And most plans offer a copay as an option during purchase since opting for it reduces your overall policy premiums.

As a trusted health insurance brand, IndusInd General Insurance (formerly Reliance General Insurance) strives to maintain 100% transparency with its customers when declaring key policy terms, such as copayment. When you realise what a copayment is, you can effectively lower your medical insurance premium while simultaneously planning for health emergencies.

Our health insurance options offer you policies with flexible copayments and even copay waivers for senior citizens. This allows you to select a plan that best suits your needs and ensures access to the most effective treatment for you and your loved ones.

What is a Health Insurance Copayment?

A copay, or copayment, in medical insurance is a system that allows the policyholder to choose the portion of medical expenses they wish to pay themselves. Then the health insurer covers the rest of the bill amount. Therefore, it is an arrangement that allows health insurance companies to split the cost of emergency healthcare with their customers.

As a policyholder, you can bring down your health insurance premium by selecting a copay clause. Usually, the copay percentage ranges from 10-30%. For instance, if you select a plan with a 20% copayment and your medical bill comes out to be ₹15,000, then you will need to pay ₹3,000 while your health insurance company will cover the remaining cost.

This is how health insurance copayment works:

• Copayments usually apply to both reimbursement and cashless claims in medical insurance.
• You should pay your share as per the copayment clause before filing a claim. For every claim.
• Since cashless settlement benefits are included, it eliminates upfront payments, thereby simplifying the hospital admission process.
• For reimbursement, you have to pay for medical expenses and then submit the receipts to claim reimbursement.

Importance of Copayment in Medical Insurance

Helps in Budgeting for Medical Expenses

If you have regular or routine medical expenses and opt for a copayment clause under your policy, you gain better control over medical expenses. This is simply because now you know your share of healthcare costs beforehand. Therefore, you will plan your spending accordingly and allocate a budget for unforeseen medical treatment bills.

Promotes Responsible Usage of Health Services

According to a report, 39 hospitals across Uttar Pradesh reported more than 6,000 fraudulent medical insurance claims under the Ayushman Bharat scheme in June 2025. This number only represents a portion of the total nationwide. Thus, health insurance companies have introduced copays to stop the misuse of health services and maintain sustainable pricing.

Lowers Premiums

Health insurance plans with copays are available at a lower premium cost, making them beneficial for healthy or young policyholders who rarely file claims. For example, our IndusInd Health Gain Policy has a 20% copay for its family floater option if the eldest family member is over 61 years. This copay can also be waived by adding a nominal charge as an add-on.

Beneficial for the Insurer and Policyholder

Depending on the type of cost sharing, the health insurance policy premiums are decided. This reasonably divides the risk between you and the insurance company, lowering your policy premiums. Senior citizens can even get adequate coverage for numerous pre-existing diseases by reducing the insurance cost with a copay clause in their policy.

What are the Types of Copays in Health Insurance?

This copayment clause is applicable when you visit a hospital for treatment that is not listed among your insurance company's network hospitals. Although you can get cashless treatment at any of the network hospitals without worrying about copayment, this may not be the case for other facilities. Visiting a non-network hospital usually requires you to bear a portion of the medical bills while making a reimbursement claim.

Your healthcare needs evolve as you grow older. It directly affects the associated treatment expenses. Hence, to adjust the risk, insurance companies often attach copayment clauses to health coverage policies made for senior citizens. IndusInd General Insurance offers add-on options to opt for a copay waiver, besides providing voluntary copayment clauses.

Specific health conditions, such as pre-existing diseases and critical illnesses, require costly medical treatments. Thus, insurance companies can implement a copayment clause for the related medical services. It means you will need to bear a part of the expense out of your pocket. Additionally, this clause is applicable when you go for any alternative treatment procedure, like AYUSH treatment.

This copayment is applied when the insured person changes their location to access any medical treatment. This arrangement is made with the consideration that medical costs are typically higher in metropolitan cities compared to small cities and towns. To mitigate this risk, health insurance companies can use copay clauses in costly urban areas.

Difference Between Copayment and Deductible

A copay is a set fraction of money that a health insurance holder must pay for certain covered medical services. On the other hand, deductibles refer to the money you have to pay yourself per plan year for covered facilities before the insurance company starts to share expenses. Here is a table portraying the other differences:

Copayment	Deductible
Copayment can either be a predetermined sum or a percentage of the insured sum.	A deductible is represented as a fixed amount.
Policyholders must settle the copay every time they file a claim.	Deductible is paid once, typically for a whole policy year.
Mostly applies to senior citizen or critical illness policies to control the added risk.	Most medical insurance plans come with deductibles.

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Should You Purchase Health Insurance With a Copay?

Advantages of Copay

Reduces Premium Cost

While choosing copayment, you are sharing the liability of medical bills with your health insurer. As a result, we lower the premium. However, to enjoy this facility, you must pay a part of the claim amount while requesting a cashless treatment or reimbursement.

Prevents Minor Claims

Since policyholders cover a portion of medical bills, they generally avoid minor claims. It helps you keep your no-claim bonus intact and also protects health insurance providers from fraudulent claims.

Helps Avert Unnecessarily High-Priced Hospitals

Policyholders may unknowingly pick costly hospitals for treatments available cheaper elsewhere. For instance, a ₹50,000 bill at a regular hospital might be ₹1 Lakh at a multi-speciality facility. With a 10% copay, out-of-pocket costs rise from ₹5,000 to ₹10,000. This cost awareness can help avoid the extra expense.

Disadvantages of Copay

Adds to Financial Burden

Policyholders have to pay a part of the bill for healthcare services when they opt for health insurance with copayment. It directly adds to their out-of-pocket expenses. Therefore, it can feel like a burden, particularly if the insured person requires frequent doctor visits.

Discourages Coverage Utilisation

As upfront payments are involved, a copay clause can discourage individuals from taking required healthcare services. Thus, it may somehow reduce access to treatments. This can harm your health and increase healthcare costs later.

Not Popular With Insurance Seekers

While copays help reduce premiums, they can also increase your out-of-pocket costs. Hence, many people avoid buying health insurance with mandatory copays. The IndusInd Health Global Policy offers voluntary copays from 10-20%, and also offers the option to waive the 20% copay for those over 61 with a suitable add-on.

Copay in IndusInd Health Insurance Plans

Unlike most health insurance companies, IndusInd General Insurance offers voluntary/ optional copayments to its customers. You can waive the copayment in different plans by opting for an add-on. Below are some of our copayment medical insurance policies:

Health Insurance Plan	Copay Clause
IndusInd Health Infinity Insurance	Copay is not mandatory; a voluntary copay of 10% will result in a 10% discount on the premium.
IndusInd Health Gain Policy	20% copay that can be waived off for individuals 61 years and above in age through an add-on option.
IndusInd HealthWise Policy	5% premium discount for voluntary copay and 25% copay, if a Zone B policyholder makes a claim on a Zone A hospital for treatment. For example, a policyholder from Zone B (rest of India) opts for hospitalisation/medical treatment at a hospital in Zone A (Uttar Pradesh, Maharashtra, Delhi, Gujarat, Bangalore and Haryana).
IndusInd Health Global Policy	Voluntary copayment of 10% to 20% on the assessed claim amount; copayment can be waived for individuals who are 61 years old and above.
Arogya Sanjeevani Policy	5% copay is applicable to all claims.
IndusInd Personal Accident 360Shield	20% copay for non-network claims on rehabilitation, medical equipment, accidental OPD, post-hospitalisation OPD and trauma counselling.

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Disclaimer: Copay percentages are subject to change. For the most up-to-date rates, please refer to the policy wording here or contact customer support.

Key Takeaways

For those who might not have a clear idea about what a health insurance copayment is, it is a fixed percentage of the medical bill that you, as a policyholder, agree to pay out of pocket each time you make a claim. The insurer covers the remaining amount.

Let's say your health insurance plan has a 10% copay, and your hospital bill is ₹7 lakhs. In this instance, you will have to pay ₹70,000, while your insurer pays the rest, ₹6,30,000, provided you have that much coverage limit. Thus, copays lower your premium, but you will need to pay a part of your treatment costs when claiming.

At IndusInd General Insurance, we offer health insurance policies that have optional copayment clauses. You can choose to opt for them during purchase, and our senior citizen plan options also offer copayment waivers with higher coverage.

You can consider checking the policy details of IndusInd Health Infinity Insurance under which we make copays optional. It offers the flexibility for policy seekers to choose a copayment based on their medical needs and budget.

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Frequently Asked Questions (FAQs)

Is copay mandatory?

No, copay is not compulsory for every health insurance plan. However, most insurance companies apply a copayment for treatments in metro cities and for senior citizen health insurance. With IndusInd General Insurance, you can waive copayment on various plans.

What is a 20% copayment in health insurance?

A 20% copayment in health insurance suggests that the insured person will have to pay 20% of the total medical expense each time they raise a claim. For example, if the bill is ₹70,000, the insurance company will pay ₹56,000, while the remaining amount will need to be settled by the policyholder.

Can I buy a health insurance plan with only OPD coverage?

OPD coverage is available as an add-on to comprehensive health insurance plans and cannot be purchased on its own. By adding it to plans like IndusInd Health Infinity Insurance, you can ensure your everyday healthcare needs are well covered up to ₹50,000*. It’s always a good idea to choose a plan that balances OPD and hospitalisation coverage so you’re prepared for both routine and unexpected medical needs.

Is a copay applicable to cashless hospitalisation?

Copay is usually applicable to both cashless hospitalisation and reimbursement under different health insurance plans.

Why are health insurance plans without copay clauses more popular, even if they are costly?

Copayment-free health insurance is more popular because it eliminates out-of-pocket payments. It ensures financial predictability and protects you from high expenses for each medical service, especially if you are managing chronic conditions or requiring frequent healthcare.

What is the copayment percentage for dependent parents under the mediclaim policy?

The copayment percentage for dependent parents in a mediclaim policy typically ranges between 10% and 30%. Although certain policies may set different rates, such as 20% or 50%, in some cases, it is mandatory for senior citizens.

How to know about my copayment liability at the time of claim settlement?

You must review your health insurance policy document carefully to find the copayment percentage. Otherwise, if you are covered under IndusInd General Insurance, you can simply open our Self-i app to check the accurate copayment amount that needs to be paid at the time of bill settlement.

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