Waiver of co-payment In Health Insurance Policy

Waiver of co-payment In Health Insurance Policy

When you get sick or hurt, your health insurance policy dives in and pays for your medical services. However, it does not pay totally. It is the most of your charges, and you have to pay the rest of the charges.  

The payment for your part is called cost-sharing. There are two types of cost sharing: deductible and co-payment. 
 

Co-payment in Health Insurance 

Co-payment is a fixed percentage of a policyholder’s amount when availing medical treatment. The insurance company will pay the rest of the amount.  

It is a fixed amount of money you are supposed to pay for a medical service. The amount is the same irrespective of how much the doctor or hospital charges for the service.  

A Case Scenario 

Ramesh, who is 65 years old, has purchased a Special Care Gold policy with a Co-payment option of 20%. After getting the treatment at a hospital, he has gained an approved claim of Rs 5 Lakhs. In this case, he must pay 20% of the costs, Rs 1,00,000 and Star Health Insurance will cover the balance.  

Waiver of Co-payment 

A policyholder is not required to pay a co-payment when a waiver of the co-payment clause is a provision in the insurance contract. Policies with a waiver of coinsurance clauses have higher insurance premiums than standard ones.  

Things to Consider Before Choosing a Co-Payment Waiver

1. Premium Costs
   Policies that include the co-payment waiver are normally costlier in terms of premiums. Determine if the additional costs will fit into your wallet and meet your health care needs.
2. Coverage by the Policy
   Check the extent of coverage provided by the policy. Ensure that the waiver applies to a broad range of treatments and is not limited to specific conditions or procedures.
3. Network Hospitals
   Find out the list of network hospitals associated with the insurer. You will most likely benefit from the co-payment waiver if you find hospitals in the network where you can receive reputable treatment.
4. Claim Settlement Process
   By examining the insurer's claim settlement process, you are sure to make the claims filing experience much more accessible. Provided the insurer does not require any co-payment from you for that, you will have an easy time filing claims.
    

Advantages of Co-Payment Waiver Policies

More peace of mind: In such policies, people are free to seek treatment without the burden of extra payment, thus lowering their stress levels during medical emergencies.

No co-payment could encourage everybody to see the doctor before a serious medical condition arises, hence better health outcomes.

Cost-effective: Although the premiums could be higher, budgeting itself is easier to predict without the trouble of co-payments that have to be budgeted for.

Disadvantages of Co-Payment Waiver Policies

Higher Premiums: The most apparent disadvantage is high premiums. Families must determine whether they can afford them with the new system.

Limited Flexibility: In some cases, there may be policy restrictions on treatments covered by the co-payment waiver.

Possible Overutilization: There may be a tendency to overutilize healthcare services because no co-payment exists.

Special Care Gold 

Special Care Gold is a unique product designed particularly for individuals with disabilities and those who are HIV/AIDS positive. This policy follows Star Health’s founding value of making quality health care accessible to all, including the most overlooked diseases and disabilities. 

This policy is chiefly created for Persons with Disabilities following the Rights of Persons with Disabilities Act of 2016. Also, it extends its coverage to persons with HIV/AIDS, as explained under the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017. 

Waiver of Co-payment in Special Care Gold 

Special Care Gold Waiver of co-payment is available on payment of an additional premium following terms & conditions. 

Premium Chart of Special Care Gold

Conclusion

A waiver of the coinsurance clause drops this need for the policyholder to share the burden and pay few of the expenses incurred out of their own pocket.