What is co-payment in health insurance?
In shortA co-payment is a fixed share of every admissible claim that you pay yourself, such as 10% or 20%. The insurer pays the rest. It often applies to senior citizens, to non-network hospitals or to treatment in a costlier city.
A co-pay is worked out after the other cuts, on what the insurer has agreed to pay. On a ₹2 lakh admissible claim, a 20% co-pay means you pay ₹40,000.
Common triggers: an age (“insured persons aged 61 and above”), the hospital (“non-network hospitals”), or the city (a “zone” co-pay when a policy bought for a cheaper zone is used in a costlier one).
Some plans let you remove a co-pay for a higher premium. Senior citizen plans often can’t.
| Admissible claim | ₹3,00,000 |
| Co-pay, 20% | ₹60,000 |
| Insurer pays | ₹2,40,000 |
If a room-limit cut applies too, the co-pay is taken on what’s left after it.
Check yours
- Search for “co-payment” or “co-pay” in your policy schedule and wording.
- Note who it applies to: everyone, an age group, certain hospitals or a zone.
- Check whether your parents’ plan has one: senior plans usually do.
Questions people ask
Is co-pay the same as a deductible?
No. A deductible is a fixed amount you pay before the policy starts paying; a co-pay is a percentage of every claim.
Does co-pay apply to cashless claims?
Yes. The hospital collects your share at discharge.
General information, not advice. Your policy’s own wording decides what it pays; IRDAI figures are from its Master Circular on Health Insurance Business (May 2024).