A deductible is the amount of money that a policyholder must pay out of pocket before their insurance company will begin to cover medical expenses. Insurance companies are only liable to pay claims that exceed the deductible amount. Having a deductible or co-pay in a health insurance plan prevents unnecessary claims and treatments by requiring the insured to pay a portion of costs. High deductible plans have lower premiums but provide no benefit if medical costs do not surpass the deductible minimum. The appropriate insurance plan depends on individual factors like medical history and health conditions.

1. DEDUCTIBLES IN HEALTH INSURANCE IN INDIA
Deductible is the certain amount of money that a policy holder or an insured person has
to pay before the insurance company starts paying up.
In simple word, all insurance companies are liable to pay the claim amount only when it
crosses the deductible; as an example, if someone’s deductible of the policy is Rs.
30000 and the claim by the insured is Rs. 40000, then the insurance company is liable
to pay only Rs. 10000.
So in any case, if the claim amount of the insured is lower than the deductible then the
insurer will not be liable for paying any amount.
Reason of deductibles in health insurance: Deductibles are important in a health
insurance plan as it prevent people from making unimportant claims or to have
unnecessary treatment and hospitalization within an insurance cover.
In the high deductible policies, people have to pay a lower amount of premium that is a
kind of saving for them as there are no unnecessary claims for small amounts but also a
No Claim bonus.
Though the increased bonuses will increase the coverage amount in the long run but
this deductible in insurance will provide zero benefit if the treatment costs do not cross
the minimum specified deductible.
Co-pay clause in health insurance: On the other hand, a co-pay is a kind of fixed
amount that the insured pays for a covered medical service and the insurer pays the
rest of the amount. This co-pay amount depends on the nature of the treatment and
medications and the co-pay clause is discouraged for people to make unnecessary
claims. It not only reduces burden on the insurers but also acts as a deterrent.
So basically the need to have a deductible or co-pay insurance depends most on the
different factors like present and past medical condition, lifestyle, pre-existing illness,
good physical condition etc. an many more. That’s why insured should read the details
fully before applying for any health insurance plan.
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Published By
Subhra Bera
www.basic-healthinsurance.com
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