Have you ever noticed a “co-pay” clause in your health insurance policy?
It means you’ll share part of the hospital bill during a claim - while the insurer covers the rest.
A co-payment reduces your premium slightly but increases your out-of-pocket expense when you actually file a claim.
Knowing how it works helps you make smarter choices, especially for senior citizen and family policies.
In Hyderabad, Telangana, PolicyBachat helps you compare no co-pay and low co-pay health plans, so you get the best coverage with zero billing shocks during emergencies.
Here’s a simple breakdown of how co-payment works and when you should (and shouldn’t) opt for it.
What iIs Co-Payment in Health Insurance?
Co-payment (or co-pay) is the fixed percentage of the hospital bill that you must pay during a claim, while the insurer pays the remaining amount.
Example:
If your policy has a 20% co-pay and the hospital bill is ₹1,00,000 -
You pay ₹20,000, insurer pays ₹80,000.
Why Insurers Include Co-Pay
- To reduce claim frequency (customers share minor costs).
- To keep premiums affordable.
- To control misuse of hospitalization for minor issues.
- To balance risk for older or high-claim profiles.
Types Of Co-Payment Clauses
| Type |
Description |
Typical Range |
| Age-Based Co-Pay |
Applied for senior citizens (60+) |
10–30% |
| Treatment-Based Co-Pay |
For specific illnesses (like knee replacement) |
10–25% |
| Location-Based Co-Pay |
For treatment outside your city / zone |
10–20% |
| Plan-Based Co-Pay |
Fixed clause in low-cost plans |
10–25% |
| Voluntary Co-Pay |
Opted by customer to reduce premium |
10–20% |
Co-Payment Vs Deductible
| Feature |
Co-Payment |
Deductible |
| Definition |
Percentage of each claim you share |
Fixed amount paid before insurer pays |
| Frequency |
Applies to every claim |
Applies once per year |
| Impact |
Affects every claim |
Affects only high-cost claims |
| Control |
Insurer decides (or optional) |
Buyer sets limit |
| Best For |
Low-cost plans, seniors |
Top-up / super top-up plans |
Benefits Of Co-Payment
- Lowers annual premium by 10–20%.
- Encourages responsible claim behavior.
- Makes senior citizen policies affordable.
- Gives flexibility to buyers with good savings.
Drawbacks Of Co-Payment
- You pay more during hospitalization.
- Large bills can cause financial strain.
- Not ideal for chronic illness or frequent treatment.
- Can reduce claim payout significantly in big cities.
Example Calculation
| Hospital Bill |
Co-Pay % |
Your Share |
Insurer Pays |
| ₹1,00,000 |
10% |
₹10,000 |
₹90,000 |
| ₹3,00,000 |
20% |
₹60,000 |
₹2,40,000 |
| ₹5,00,000 |
30% |
₹1,50,000 |
₹3,50,000 |
Local Insights For Hyderabad
- Avg. co-pay rate in top policies: 18%
- % of buyers choosing no co-pay option: 22%
- Common co-pay range for senior plans: 10–30%
- Top no-co-pay insurers: HDFC ERGO, Star Health, Care Health
How To Choose Smartly
- If you’re below 45 and healthy - a small co-pay (10%) can help lower premiums.
- If you’re above 60 or have existing conditions - go for no co-pay.
- Always check if co-pay applies to all claims or only select ones.
- Read policy fine print - some plans hide city-based co-pays.
- Compare total long-term savings vs claim exposure.
Plans With Zero Or Low Co-Pay (2026)
| Insurer |
Plan |
Co-Pay % |
Key Highlight |
| Care Health |
Care Advantage |
0% |
Full coverage, no hidden clauses |
| HDFC ERGO |
Optima Restore |
0% |
Lifetime renewability |
| Star Health |
Family Optima |
10% |
Optional co-pay removal |
| Niva Bupa |
Health Companion |
0% |
Global emergency cover |
| Aditya Birla Health |
Activ Health Platinum |
0–10% |
Wellness rewards |
How To Remove Co-Pay Clause
- Choose “Co-Pay Waiver Rider” (available in many plans).
- Request removal at renewal (subject to underwriting).
- Port to a new insurer offering no-co-pay options.
Policybachat Tip
A 10% premium saving from co-pay isn’t worth it if one big hospital bill wipes out your savings. Always calculate the real impact before opting in.
Tax Note
Even if you pay a share via co-pay, your full premium still qualifies for Section 80D deduction.
FAQs
What does co-payment mean in health insurance?
It’s the percentage of each claim amount you must pay from your pocket.
Does co-pay apply to every claim?
Yes, unless specifically waived for certain treatments.
Can I remove co-pay from my policy?
Yes, via co-pay waiver rider or policy upgrade.
Why do senior plans have co-pay?
To keep premiums affordable despite higher claim risk.
Is co-pay mandatory in all plans?
No - many policies offer zero co-pay options.
Is co-pay good or bad?
Good for saving premium if you rarely claim; bad if frequent hospitalizations.
What happens if I don’t pay my co-pay share?
Insurer deducts it from claim settlement.
Does co-pay affect tax benefits?
No, premium deduction remains unchanged.
What is better - co-pay or deductible?
Deductible suits top-up plans; co-pay fits base policies.
Which plan offers no co-pay in 2026?
Care Advantage and HDFC ERGO Optima Restore.
Customer Reviews
- “Learned how co-pay really works - great explainer.” - Ravi Menon, Kochi
- “Switched to no co-pay plan on renewal.” - Sneha Iyer, Bengaluru
- “PolicyBachat clarified hidden co-pay clauses - saved me later.” - Vikram Desai, Mumbai
- “Excellent comparison of co-pay vs deductible.” - Ananya Reddy, Delhi
- “Helpful for senior citizen policy buyers.” - Kavya Nair, Hyderabad
- “Now I always check co-pay before buying.” - Rajesh Rao, Pune
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