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Why do Health Insurance Policies have a Co-Pay Clause Thus, insurers might add a co-pay clause for treatments undertaken at large cities. Co-Pay for Hospitalisation in Metro Cities: Hospitalisation costs at a metro city are usually much higher than treatment costs at a smaller city or town.In this case, cashless claims will be borne fully by the insurer. Co-Pay for Reimbursement Claims or Treatment at Non-Network Hospitals: Certain insurance providers will specify a co-pay clause only for reimbursement claims or treatments undertaken at non-network hospitals.Co-Pay on Senior Citizen Policies: Most health insurance plans that are offered to senior citizens come with an inbuilt co-pay clause since treatment costs for senior citizens are usually quite expensive.Thus, the policyholder will need to pay a part of the claim amount for all claims raised. Co-Pay on all Medical Bills: In this case, the co-pay clause, whether mandatory or voluntary, is applied to all claims that are raised.The co-pay clause may be applied to health insurance plans in the following manner: Not all health insurance policies come with a mandatory co-pay clause. The remaining 10% or Rs.1,000 will have to be borne by you. Thus, for example, if you have opted for a co-pay of 10% and you raise a claim for Rs.10,000, the insurance provider will pay only 90% of the claim amount. Similarly, opting for a low co-pay will increase your premium payable, but will reduce the amount that you have to pay in the event of a claim. Opting for a high co-pay will lower your premium payable, but will increase the amount that you have to pay in the event of a claim.

While certain health insurance policies come with a mandatory co-pay clause, other health insurance plans give policyholders the option to choose a co-pay percentage as per their needs. Co-pay refers to that portion of the claim amount that is to be borne by the policyholder.