Co-Payment
What it means, and what it does to a claim.
A share of every approved claim that you pay yourself, as a fixed percentage. If your policy has a 20% co-pay and the hospital bill is ₹1 lakh, the insurer pays ₹80,000 and you pay ₹20,000.
Why it matters
A co-pay applies to every claim, forever — it is not a one-off excess. It is the most common reason a policy that looked cheap turns out not to be, and it is often attached quietly to senior-citizen plans and to cheaper variants of otherwise good ones. Check for it before you compare premiums, because a plan with a co-pay is not comparable to one without.
The legal definition
Co-Payment means a cost sharing requirement under a health insurance policy that provides that the Policyholder / Insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
Quoted verbatim from an IRDAI-filed policy wording. Definitions are standardised across insurers, but the limits attached to them are not — always read your own policy schedule.
Related terms
- Deductible — An amount you cover yourself before the policy starts paying at all.
- Room Rent — What the hospital charges per day for your room and board.
- Waiting Period — A stretch of time at the start of a policy when certain conditions are not covered yet.
- Sum Insured — The maximum the insurer will pay in a policy year.
Disclaimer: Figures shown here are compiled from IRDAI annual reports and public grievance disclosures, and from insurer public disclosures and policy wordings. Claim settlement ratios and complaint volumes are three-year averages for FY 2024–26. Premiums are indicative illustrations for the stated profile, not quotes — your actual premium depends on your age, health, city, habits and underwriting. Scores are Myinsurancebro's own assessment. Always read the official policy document and speak to an advisor before buying. Myinsurancebro is an IRDAI-licensed insurance advisor — we do not manufacture or underwrite any insurance product.