Question 1

What is co-payment in health insurance?

Accepted Answer

Co-payment is a clause where you agree to pay a fixed percentage of every claim yourself, with the insurer covering the rest — common for senior citizen policies, or sometimes offered voluntarily by younger buyers in exchange for a lower premium.

Question 2

How is my co-payment share calculated?

Accepted Answer

Your share is simply the co-payment percentage applied to the total claim amount — a 20% co-payment on a ₹5 lakh claim means you pay ₹1 lakh out of pocket, and the insurer pays the remaining ₹4 lakh.

Question 3

Why do senior citizen policies often have mandatory co-payment?

Accepted Answer

Insurers use co-payment clauses to manage the higher claim frequency and cost typically seen in older age groups, which also helps keep the policy's premium more affordable than it would be without any co-payment.

Question 4

Can co-payment apply on top of a room rent sub-limit deduction?

Accepted Answer

Yes — if your policy has both clauses, they can compound: a room rent proportionate deduction reduces the eligible claim amount first, and co-payment is then often applied on top of that already-reduced amount, increasing your total out-of-pocket cost further.

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