Quick Summary
A copay, or co-payment, is a pre-agreed percentage of an approved claim that the insured person bears, while the insurer pays the balance. For example, on a 10% copay, an employee pays ₹10,000 of a ₹1,00,000 approved bill and the insurer pays ₹90,000.
Copay in Group Health Insurance
- Lever on premium: Employers sometimes accept a copay to reduce the premium on a group health policy — the trade-off is a higher share of each claim for employees.
- Targeted copays: A copay may apply only to specific cases, such as parents/in-laws, treatment in higher-cost metro cities, or particular procedures.
- Not a deductible: A copay is a percentage of every admissible claim, whereas a deductible is a fixed amount you pay before cover begins.
Best Practice for HR Teams
Communicate any copay clause clearly at enrolment, and show how it interacts with the sum insured and room rent limit, so employees are not surprised at discharge.
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