Everything to know about Copay health insurance

By: Answerout


The health insurance industry is the victim of various fraudulent claims. These fraudulent claims have cost the health insurance sector a considerable amount of money. Not only health insurance sector is suffering from unethical activities but also affected innocent customers. To put an end to this copay in health insurance came into the picture. Now mostly all the health insurance policy comes with the clause of Copay health insurance. For someone who is buying health insurance for the first time, it is important to understand everything about Copay.

Copay refers to the arrangement between the insurer and insured where a certain amount of the claim is to be borne say 10 percent by the insured and the rest is paid by the insurer. Thus the claim under Copay health insurance is sharing basis as per the percentage basis. The health insurance policy of the individual will include the clause copay along with the percentage. Thus one must read the insurance policy to be aware of what amount of medical expenses will have to be borne by them.

The Copay clause was needed for an hour for insurance companies as it helps them a good portion of their expenses. Besides this, there are various reasons why the Copay clause was included in the health insurance policy. These are mentioned below:

  • As the claim is to be paid on sharing basis, this discourages the policyholders to make claims over common diseases such as cold, cough, etc. In absence of this clause, many people used this claim and the insurance company was technically responsible to pay for it.
  • The inclusion of the Copay clause brings a sense of ownership among the insured as they now know they are also responsible for their medical expenses.
  • This also discourages people from getting the treatment from expensive hospitals unnecessary. As some part of the expensive medical bills are to be borne by the individual as well.

Hence because of these reasons, Copay has become an essential feature in a health insurance policy. Before selecting the policy with the Copay clause one must take care of two factors. These are mentioned below:

  • Copay percentage: It is important to know about the copay percentage as this will clarify the cost will the policyholder is required to pay.
  • Premiums: As under Copay health insurance the expenses are to be borne by both parties thus one can expect a lower premium than the general health insurance. It is thereby important that one compares their health insurance with the Copay clause with general insurance and choose the policy only when the premium charged by the former is less.

Hence these are the basic factors that one must give attention to before buying of health insurance policy with a Copay clause.

Many a time the terms copay and co-insurance are used interchangeably. It is thereby important to understand their difference. Under co-insurance, the agreement between the insured and insurer for paying medical expenses is based on a percentage basis. Some plans might have 90-10 while others 80-20 and so. It is however to remember that majority of the portion of medical expenses will always be borne by the insurer. Under Copay insurance policy the amount to be paid by the insured is fixed no matter what the total expense of medical bills is.

Co-pay health insurance has some features that make it unique from a different kind of health insurance policy. Some of these features are mentioned below:

  • The majority of the claim of the medical bill under Copay health insurance is paid by the insurance company and only some percentage say 10 percent is to be borne by the insured.
  • The scope of copay medical health insurance includes almost everything from doctor’s fees, hospitalization expenses, and lab tests to medicines.
  • The Copay health insurance with a higher premium monthly has a low Copay percentage i.e. the insurer has to pay less amount of medical expenses to claim.
  • This type of insurance plan applies to senior citizens.
  • The main aim of the inclusion of this Copay clause is to ensure that there are no fraudulent and unnecessary claims.

Hence these features make the Copay health insurance a unique insurance policy. Copay health insurance's importance has grown in the recent past as it has helped in reducing the burden of the insured in paying larger premium payments. Besides this, the main benefactor of this policy is a senior citizen who can get cover under this policy for their pre-existing diseases at lower premium payment. The introduction of the Copay insurance clause has also led to people stopping from taking unnecessary luxury facilities as they have to bear the expenses too.

The copay health insurance clause was much needed in healthcare insurance. It is a win-win situation for both the insured and insurer, however to get the real benefits one must choose Care Health Insurance that provides all the essential information to their customers so they can get the best policy without any challenge.

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