The provision for 10 percent co-payment of health claims by policyholders may soon become a reality. The General Insurance Council is considering a proposal which could be implemented from January 1, 2027, which would put the burden of hospitalisation costs on the person insured.
As per a report by TOI, the non-life insurance companies are considering implementing 10 percent co-payment of admissible inpatient hospitalisation costs in retail health policies. It means that for a person’s total hospitalisation bill of Rs 5,00,000, Rs 50,000 would have to be personally covered. This includes expenses arising out of all admissible inpatient hospitalisation, including accident-related cases.
The customers’ share in the payment would be capped at Rs 5 lakh per claim, and the annual premiums would be lowered. Moreover, along with the co-payment provision, the General Insurance Council also plans to establish common hospital empanelment and a formal mechanism for resolving disputes between insurance companies and hospitals.
Whether the policyholder makes the payments through cashless procedures or reimbursement, the 10 percent contribution would remain a necessity. The policyholder, as per the proposed plan, would have to bear the designated part of the hospitalisation expenses covered by insurance.
Outpatient or OPD claims would remain outside the scope of the proposal. The policies covered by it include retail indemnity products, retail-under-group policies, indemnity components of combi products, internal migrations and portability business.
One cannot choose to waive off, reduce, or modify the co-payment amount through any means, including recovery from another health insurance policy.
It implies that even those who buy expensive coverage by paying higher premiums to ensure full coverage at times of medical emergencies would have to make an additional 10 percent payment when admitted to a hospital. Health insurance proves to be an essential support even for those who otherwise would find it difficult to bear the complete expense of medical services.
As per the report, the measure is sought based on the logic that hospitals may extend hospital stays, prescribe additional diagnostic tests and procedures if the patient has comprehensive insurance coverage. Also, higher-category rooms may incur higher costs since their rent includes doctors’ fees and procedural charges.
Thus, insured patients may receive higher bills from hospitals, along with increased demand for such services, leading to higher healthcare costs.
