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What is Copay in Insurance?

Over the years, availing competent healthcare facilities at reasonable rates has become a daunting task. In addition, medical emergencies can turn the scenario even worse. To avoid such situations and to protect yourself from financial liability, health insurance is the best option to opt for.

However, there is one particular clause in health insurance that not many are aware of. That is Copay. Wondering what is copay in insurance? Let us clear that for you.

Meaning of copay in health insurance

Copay in simple terms is a clause and if your insurance has it, this means that you have agreed to pay a certain amount of the medical expense. Whereas, the rest will be covered by the insurer. There are several insurance companies that offer this clause in their policies. The amount related to copay is usually fixed for varying drugs and services. However, this may differ as per the medication and treatment required.

For Example: If your policy has a copay clause of 20% and the medical bill has amounted to a total of Rs. 50,0000. In such a case, you will be liable to pay Rs. 10,000 and the rest of the amount i.e., Rs. 40,000 will be covered by the insurance company.

Features of copay

To get a better understanding of what is copay in health insurance, you first have to be aware of its features. They are as follows:

  • In India, the copay clause is usually applicable to senior citizens.
  • It is more prominent in major cities that are established where the treatment of cost is higher as compared to the smaller cities.
  • The percentage of copay varies as per the medical service that you opt for.
  • One of the most important things to be aware of is the low copay amount. It might seem very attractive, however, if you opt for a lower amount, you’ll be required to pay a higher premium.

Why is Copay needed sometimes?

  • Avoids the misuse of policy: An important reason why insurance companies have copay clauses is to prevent any claims that are unnecessary. For example, a person might want to raise a claim against the treatment of a disease that does not require a higher cost. Having a copay clause prevents any sort of misuse of the policy.
  • Ensures the right use of policy: Since copay requires you to put in your money as per the decided percentage for the payment of treatment, it enhances your involvement. For the policyholder, this eventually results in the honest and transparent use of the policy.
  • Reduces Risk and Liability of Insurance Providers: Under the copay clause, the insurer is not required to pay the full amount. This tremendously reduces the risk and liability of the insurance company.


Important: A health insurance plan with a Copay clause may seem like an affordable option but your coverage requirement is something that you should determine before opting for it. Moreover, you should also be sure that you hold enough finances to pay your share of the medical bill.

Now, that you’re aware of what is copay in health insurance, make well-informed decisions and opt for a health insurance policy with or without a copay clause, anything that suits you best.

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