What is Co-payment in health insurance?
Co-payment is the fixed percentage of each approved hospital claim that you pay yourself, while the insurer pays the remaining balance. It is calculated on the admissible claim amount, not your total cover, and crucially it does not reduce your sum insured — only the insurer's share is deducted from it. Many senior-citizen and zone-based plans carry a mandatory co-pay.
In plain English
On every hospital bill the insurer approves, you chip in a set share (say 10 or 20 percent) and they pay the rest. Your total cover stays untouched.
A quick example
On a ₹2,00,000 approved claim with a 20% co-pay, you pay ₹40,000 and the insurer pays ₹1,60,000. If your sum insured was ₹10,00,000, it falls only by the ₹1,60,000 the insurer paid — to ₹8,40,000 — not by your ₹40,000 share.
What IRDAI says
IRDAI's standard definition treats co-payment as a cost-sharing percentage of the admissible claim; only the amount the insurer actually pays reduces the sum insured, never your co-pay share.
Where to find it in your policy
Not sure where this sits in your own policy? CoverSure reads the full document and pulls up the exact clause for you.
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No. Only the amount the insurer actually pays is deducted from your sum insured; your co-pay share is paid out of pocket and leaves the cover untouched.
No. A co-payment is a percentage of each approved claim, while a deductible is a fixed rupee amount you clear before the insurer pays anything. Some plans carry both.
Often yes — many plans make co-pay optional, or charge it only for senior citizens or treatment in higher-cost zones. A voluntary co-pay lowers your premium, so check the schedule before buying.
Reviewed by
Atul SharmaAVP, Founder’s Office at CoverSure · 7+ years in insurance (ex-Tata, Ditto, Cholamandalam)
