How Is Health Insurance Deductible Different From Co-payment Clause?

What Are Co-pay And Deductible In Health Insurance

Online health insurance policies have several clauses that govern how medical expenses will be shared between the insurance provider and the insured. Two such clauses are health insurance deductible and co-payment. These two clauses are often confused, but they are not the same thing. In this essay, we will examine the differences between the two clauses and their impact on the insured.


The final admissible claim amount is what the insured and the insurer split equally. When receiving medical care, the insured person is required to pay a portion of the cost; the insurer will cover the remaining balance. *


The predetermined sum that the policyholder pays when buying the coverage is known as the deductible. It may be given to the insurer as a set amount or as a percentage. This sum must be paid annually. Even if there is no claim, it is not refundable. Your rate will decrease the larger the deductible is. *

A co-payment is a set sum that the policyholder must pay each time they receive a specific kind of healthcare treatment. In the event of a claim, the insured agrees to pay a certain amount of the claim. The insurance provider will pay the remaining amount. For instance, if someone accepts a 10% co-pay and the authorised claim is for Rs 1 lakh, he will have to pay Rs 10,000. The insurer will cover the remaining 90%. *

A deductible is a set sum of money that a policyholder must pay each year before they avail full benefits of health insurance. When the deductible is satisfied, the health plan starts to pay its portion of the medical expenses. Lower rates will result from higher deductibles and vice versa. ## It may also be referred to as an out-of-pocket cost. One has a deductible of Rs. 1,20,000, for instance. He visits a doctor after contracting the flu in January. Rs 12,000 is the doctor’s bill. He will pay the entire price because he did not pay his deductible this year. He has Rs. 1,08,000 remaining after paying the doctor’s costs towards his annual deductible. He had an accident in March and broke his arm. The doctor’s bill now totals Rs. 1,80,000. In this case, he will pay Rs. 1,000,000 of the bill and his insurer will cover the remaining amount. He had his cast taken off in April. The total amount due is Rs 30,000. As his deductible for this year has been satisfied, he is not required to make any further payments. His insurance provider will cover the entire cost. *

A deductible is a one-time annual expense, which is how it differs from a co-payment. The policyholder doesn’t have to pay any more deductible until the following year after meeting his deductible requirements for the current year. Co-payments are a continuous procedure. Every time the policyholder receives medical care, he continues to make co-payments. *

Understanding the difference between what is a health insurance deductible and a co-payment is important for anyone seeking medical insurance coverage. The deductible is the amount the insured must pay before the insurance provider starts covering medical expenses. The co-payment is a fixed amount the insured pays for each medical visit, while the insurance provider covers the rest of the cost. Both clauses play important roles in determining how much the insured will pay for medical expenses. It is important to note that health insurance deductibles and co-payments can vary widely between different insurance plans and providers. *

By understanding the nuances of these clauses, the insured can make informed decisions when selecting a health insurance policy that meets their needs with the benefits of health insurance.

* Standard T&C Apply

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. Standard T&C apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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