Now Reading: 10% health insurance co-pay proposed from 1 January 2027
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10% health insurance co-pay proposed from 1 January 2027
Non-life insurers are considering a 10% co-payment on retail health insurance claims from 1 January 2027, with the policyholder's contribution capped at Rs 5 lakh per claim. The proposal, being considered by the General Insurance Council, would also include common hospital empanelment and a formal dispute resolution mechanism between insurers and hospitals.
Under the proposal, the co-payment cannot be waived, reduced or modified through riders or endorsements, and the policyholder's contribution cannot be recovered from another policy. Experts say the actual out-of-pocket expense could be higher than 10% due to room-rent limits, deductibles, sub-limits and exclusions. No standard premium reduction has been announced.
Indian Opinion Analysis
The proposal shifts significant cost risk to policyholders, who must arrange 10% of hospitalisation costs even under cashless claims. The Rs 5 lakh cap per claim protects against catastrophic expenses above Rs 50 lakh, but sub-limits and exclusions could push actual out-of-pocket costs higher than the stated percentage. With no standard premium reduction announced, consumers cannot yet weigh savings against added exposure. The General Insurance Council's next step, finalising the proposal for implementation, will determine whether the trade-off becomes reality.
Source: livemint.com
This brief was synthesised by AI from the source linked above. Methodology and corrections.
