In a bid to ensure optimal utilization of benefits by policyholders, employers are increasingly resorting to co-payment, whereby up to 25 per cent of the claim amount will have to be borne by the employee. The insurance company will pay the balance.
Co-payment provides tangible benefits to companies in terms of reduced insurance premium. Typically, the co-payment ratio for the employee ranges from 10-25 per cent. So, for every claim of Rs 1 lakh the policyholder has to shell out Rs 10,000 from his/her pocket, before the insurer pays up the remaining Rs 90,000.
There are allegations of hospitals making inflated bills. “Co payment in health insurance policies will also ensure that hospitals stay away from such practices,” said an insurance company official. For New India Assurance, almost 20 per cent of their group health insurance policies have a co-payment clause, said general manager Segar Sampathkumar.
According to a recent report by ICICI Lombard General Insurance, the preference for co-pay has increased to 18 per cent of all group health insurance policies in fiscal 2012-13 from 16 per cent in the year-ago period.
Interestingly, industry experts say, many insurance companies have started introducing co-pay clause for individual health insurance policies sold to senior citizens. For instance, New India Assurance has a co-payment clause for new policies sold to individuals over the age of 55.
