Waiver of co payment in health insurance policy

Q: 1. Difference between deductible and co-payment?

Deductibles A deductible is a set amount you pay each year (or each benefit period) before your health insurance pays in full. Co-payment A co-payment is a standard amount you pay every time you get a particular type of healthcare service, and co-pays will likely be smaller than deductibles.

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Introduction

When you get sick or hurt, your health insurance policy dives in and pays for your medical services. However, it does not pay totally. It is the most of your charges, and you have to pay the rest of the charges.

The payment for your part is called cost-sharing. There are two types of cost sharing: deductible and co-payment.

Co-payment in Health Insurance

Co-payment is a fixed percentage of a policyholder’s amount when availing medical treatment. The insurance company will pay the rest of the amount.

It is a fixed amount of money you are supposed to pay for a medical service. The amount is the same irrespective of how much the doctor or hospital charges for the service.

A Case Scenario

Ramesh, who is 65 years old, has purchased a Special Care Gold policy with a Co-payment option of 20%. After getting the treatment at a hospital, he has gained an approved claim of Rs 5 Lakhs. In this case, he must pay 20% of the costs, Rs 1,00,000 and Star Health Insurance will cover the balance.

Waiver of Co-payment

A policyholder is not required to pay a co-payment when a waiver of the co-payment clause is a provision in the insurance contract. Policies with a waiver of coinsurance clauses have higher insurance premiums than standard ones.

Special Care Gold

Special Care Gold is a unique product designed particularly for individuals with disabilities and those who are HIV/AIDS positive. This policy follows Star Health’s founding value of making quality health care accessible to all, including the most overlooked diseases and disabilities.

This policy is chiefly created for Persons with Disabilities following the Rights of Persons with Disabilities Act of 2016. Also, it extends its coverage to persons with HIV/AIDS, as explained under the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017.

Waiver of Co-payment in Special Care Gold

Special Care Gold Waiver of co-payment is available on payment of an additional premium following terms & conditions.

Premium Chart of Special Care Gold

Plan Age in years\SI Rs	With 20% co-pay		Waiver of 20% co-pay
	Rs.4 lakhs	Rs.5 lakhs	Rs.4 lakhs	Rs.5 lakhs
	1A
Up to 35	12,272	13,344	15,340	16,680
36-45	15,952	17,344	19,940	21,680
46-50	22,336	24,288	27,920	30,360
51-55	29,040	31,568	36,300	39,460
56-60	37,760	41,040	47,200	51,300
61-65	49,088	53,360	61,360	66,700
66-70	63,808	69,360	79,760	86,700
71-75	82,960	90,176	1,03,700	1,12,720
76-80	1,07,840	1,17,232	1,34,800	1,46,540
Above 80	1,40,208	1,52,384	1,75,260	1,90,480
Note: Premium for 66 years and above age are applicable only for Renewals \| A=Adult

Conclusion

A waiver of the coinsurance clause drops this need for the policyholder to share the burden and pay few of the expenses incurred out of their own pocket.

FAQs

1. Difference between deductible and co-payment?

Deductibles

A deductible is a set amount you pay each year (or each benefit period) before your health insurance pays in full.

Co-payment

A co-payment is a standard amount you pay every time you get a particular type of healthcare service, and co-pays will likely be smaller than deductibles.

2. Is a policy with a waiver of the co-payment clause a better option?

Choose health insurance as per your age, income, dependents, medical history of you and family and lifestyle. You can always change the sum insured amount as per the increasing stages of life.

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The Information including but not limited to text, graphics, images and other material contained on this blog are intended for education and awareness only. No material on this blog is intended to be a substitute for professional medical help including diagnosis or treatment. It is always advisable to consult medical professional before relying on the content. Neither the Author nor Star Health and Allied Insurance Co. Ltd accepts any responsibility for any potential risk to any visitor/reader.