Insurance companies want policyholders to pay 10% of health claims
· Business · Times of India, Zee News
Non-life insurers propose a 10% co-payment by policyholders on retail health policies from January 1, 2027, with the patient's contribution capped at Rs 5 lakh per claim. The General Insurance Council is considering the change, which would pair the co-pay with common hospital empanelment and a formal dispute-settlement mechanism between insurers and hospitals. Customers would receive lower annual premiums in return for the co-payment, which applies to inpatient hospitalisation costs including accident claims settled via cashless or reimbursement procedures. Outpatient claims remain outside the scheme, and the 10% contribution cannot be waived, reduced, or recovered from another policy. The proposal covers retail indemnity products, group policies, combi products, and portability business. The logic behind the measure is that hospitals may order additional diagnostic tests and extend stays when patients have comprehensive cover, potentially inflating bills.
Why it matters
Policyholders buying retail health insurance from January 2027 will face a mandatory 10% out-of-pocket share on claims, capped at Rs 5 lakh, while insurers offer lower premiums in exchange. The rule applies to comprehensive policies, meaning even those with full coverage must contribute a portion of admissible hospitalisation costs. The proposal could discourage uptake of high-value policies if customers perceive the co-pay as an unfair additional cost on top of premiums.
Read the original report — Times of India
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