What Is Co-payment ?

Copayment (or Copay) in insurance is a fixed amount that the insured person must pay out-of-pocket for a specific healthcare service . It is typically required at the time of service and is a way for insurance companies to share the cost of healthcare with the insured.

Key Features of Copayment:

1. Fixed Amount:

   • The copayment amount is predefined in your insurance policy.

2. Cost-Sharing Mechanism:

   • Copayments help insurers manage the cost of claims and encourage responsible use of healthcare services by the insured.

3. Separate from Deductibles:

   • The copayment is separate from the deductible (the amount you pay before insurance starts covering expenses). In some plans, you must pay the deductible first before copayments apply.

Example:

Suppose your health insurance policy specifies a 20% copay for outpatient consultations. This means you are responsible for 20% of the total cost, and the insurer covers the remaining 80%.

1. If the consultation fee for a doctor's visit is ₹2,000:

   • Your Copay (20%): ₹400
   • Insurer’s Share (80%): ₹1,600

2. If the treatment cost for a minor procedure is ₹10,000:

   • Your Copay (20%): ₹2,000
   • Insurer’s Share (80%): ₹8,000