Hyderabad: Kumar has a health insurance cover of Rs 15 lakh. While taking the policy, he opted for a 20 per cent 'co-pay' thinking that it will ease the burden of premium to some extent. He initially thought this 'co-pay' limit would not be a big burden on him financially. Unexpectedly, Kumar got admitted to hospital and incurred a bill of Rs 8 lakh. Due to the 'co-pay' condition, he had to pay up to Rs 1.60 lakh from his savings.
Like Kumar, many people are taking health policies with the 'co-pay' condition in order to reduce the premium and immediate relief. Under the 'co-pay' provision, the policyholder is required to pay a certain percentage of the bills. Though there is little relief immediately because of this condition, the policyholders are certain to face problems in future. We should go only for those policies that pay the total claims regardless of their premium being a bit higher.
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In some special situations, though we have insurance policies with provision for full claims, the companies may insist and make 'co-pay' applicable. For example, some insurance companies bring up 'co-pay' when fully covered policyholders join hospitals not covered in their network. So, you should check carefully whether you have a network hospital in your surroundings or not. If not, intimate the same to your insurance company in advance and discuss it with them. Then there is a chance the insurance company will give you an exemption from the 'co-pay' condition under emergency situations.
Those living in tier-2 cities should take extra caution while taking health insurance coverage. When they go for medical treatment in tier-1 cities, the companies will make 'co-pay' applicable to them. So, all care should be taken at the time of taking the policy. Sometimes, the companies will ask for a 'co-pay' when we have been admitted to corporate hospitals. Especially room rent and ICU charges will be on the higher side. In some hospitals, room rent will be higher at Rs 8,000 per day. Some insurance policies impose a limit on room rent. Under such circumstances, 'co-pay' is unavoidable.
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We have to keep in mind that if we have prior illnesses, the insurance companies will apply 'co-pay'. If we wait for a pre-defined period after taking the policy, this condition will be withdrawn. So, we have to be careful at the beginning itself whether we need a total claim from the first day of the policy or not. We have to check whether we can wait for some time before getting the full claim provision. Those in the lower age group can opt for 'co-pay' to reduce the burden on premiums. But, it is better if those, who suffer from existing illnesses and who are above 45 years of age, go for policies without 'co-pay' and such other sub-conditions.
