Health Insurance Rules: Big news for common people. This news might be heading your way if you have health insurance! There’s a proposal on the table to introduce a 10% co-payment requirement for retail health insurance plans starting January 1, 2027. The General Insurance Council is looking into this possibility, according to recent news coverage. Here’s what it would mean: you’d cover 10% of your approved hospital bills out of your own pocket, while your insurance company handles the remaining 90%. The good news? There’s a safety net—the co-payment would be capped at Rs 5 lakh per claim. Let’s dive deeper into what this could mean for your health insurance and your wallet.
Let’s break it down
Imagine your approved claim comes to Rs 5 lakh. You’d pay 10%, which is Rs 50 thousand, and your insurance company would cover the rest—Rs 4.5 lakh. Here’s something important to remember: the co-payment applies only to the amount your insurance company approves, not your entire hospital bill. Picture this scenario: your hospital bill is Rs 5 lakh, but your policy only covers Rs 4 lakh. Your co-payment would be 10% of Rs 4 lakh, which equals Rs 40 thousand. You’d also need to pay that Rs 1 lakh that falls outside your policy coverage.
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Now, here’s the flip side. In return for paying less in premiums, you might end up spending more when you actually need treatment. This proposal would apply to both cashless and reimbursement claims. Let’s say you have a valid claim for Rs 3 lakh—you’d pay Rs 30,000 as your co-payment, and your insurance company would cover Rs 2.7 lakh. With cashless treatment, the company sends its share straight to the hospital. With reimbursement, you pay first and get your money back later based on your policy details.
These things also need to be kept in mind
It’s also unclear whether customers will be able to choose another plan by paying a higher premium to avoid the 10% co-payment. Therefore, when purchasing a policy, one should not base their decision solely on the low premium. Customers should also consider the maximum out-of-pocket amount they may have to pay for major treatment, whether there are any sub-limits for the illness or treatment, which expenses are not covered, and whether a deductible applies.
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According to experts, a 10% co-payment does not necessarily mean a 10% reduction in premiums. Actual savings can typically be around 4% to 7%, but this will vary from policy to policy and customer.