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By clicking Start Now, you authorize Niva Bupa to Call/SMS/Whatsapp on your registered mobile overriding DNCR.Co-pay Health Insurance
Co-pay health insurance requires the insured to pay a fixed percentage of medical expenses out of pocket, while the insurer covers the remaining cost. This helps lower premium costs but means sharing treatment expenses during claims.
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Why Choose Niva Bupa?
Still Need Reasons? Here They are:
Trusted by over 1.4 crore Indians, we combine reliability with innovation to keep your health safeguarded, always.With 10,400+ cashless hospitals and a 30-minute claim process, quality healthcare is truly accessible and stress-free.
30 min
Cashless Claim Processing 1
15 Lakh+
Claims paid since inception 2
1.4 Crore+
Happy customers served till date
Custom Health Insurance Plans designed for You
A plan that rewards you for starting young
Starts from
₹8,6321
Annual Premium
₹5,00,000
Sum Insured
- Lock the age, pay premiums as per entry age till you claim
- Don’t lose what you don’t use. Carry forward the balance sum insured
- Maternity coverage including IVF, Adoption and more
- Use and get back your base coverage. Unlimited times and forever
Nothing Seems Impossible. The Most Comprehensive health insurance plan.
Starts from
₹7,8212
Annual Premium
₹5,00,000
Sum Insured
- Save as you age. Pay as per entry age, until you claim.
- Use and get back your base coverage. Unlimited times and forever.
- Don’t lose what you don’t use. Carry forward the balance sum insured
- Up to 30% discount on renewal premium basis step count
A Health Insurance Plan that works your way
Starts from
₹4,8043
Annual Premium
₹5,00,000
Sum Insured
- Pay Apne Hisaab se! Flexible or One Time. Sooner the payment, higher the discount
- Get 50% of your premium back, accumulate it, and even get 10% bonus for life. No waiting periods or exclusions on this amount.
- Get ₹5,000, if treatment taken in any Govt. hospital and claim not paid under this policy
- Access unlimited digital consultations with general physicians through our mobile app.
A comprehensive health insurance plan,with coverage for you and your family according to your needs and lifestyle.
Starts from
₹11,5714
Annual Premium
₹5,00,000
Sum Insured
- Comprehensive coverage up to ₹3 Cr
- In-built travel insurance coverage for multiple trips in a year
- Modern Treatments coverage
- Maternity (worldwide) and new born baby cover
The Smart Health Insurance Plan with Smart Feature to keep your family protected
Starts from
₹11,7755
Annual Premium
₹5,00,000
Sum Insured
- No Room Rent Capping
- Modern Treatments Covered up to Sum Insured
- Hospitalisations of 2 hours or more covered
- One time refill of Base Sum Insured, even for same illness.
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Get comprehensive coverage for your entire family under a single health insurance plan.
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How does our Claim Process work?
Get to know the steps involved in the claim Process, Whether it is a planned or emergency hospitalisation. Filling a claim is made easy by choosing any of the following ways:
Hospital Admission:
Get admitted to a Niva Bupa network hospital.
Identification:
Present your Niva Bupa Health Card or policy number along with valid ID (Passport/PAN card/Voter’s ID) to the hospital staff.
Pre-authorisation:
The hospital will verify your details and submit a pre-authorisation request to Niva Bupa.
Niva Bupa Confirmation:
After verification, Niva Bupa will confirm coverage to the hospital via fax and email, and notify you by text and email, typically within 30 minutes of the request.
Final Settlement:
Upon completion of treatment and necessary formalities, the hospital will settle the claim with Niva Bupa according to your policy terms.
All you need to know about Copay Health Insurance
When referring to the health plan, the phrase "copayment" describes the amount of the claim the policyholder is expected to pay out of pocket, with the insurance company paying the remaining balance. Many insurance providers offer insurance plans with copayment requirements, while others allow for a voluntary copayment. A voluntary copay is an option that policy owners can purchase and enjoy at a lower price.
Copay health insurance is a type of health plan where the policyholder must pay the price by themselves (known as a copay) before the insurance company covers the rest of the costs. The copay amount is typically fixed but can also be a percentage of the total cost. The insured person must pay the copay out of pocket before the insurance provider will cover the rest of the expenses.
Copay health insurance plans are popular because they help to keep health care costs down by incentivizing policyholders to be more cost-conscious when selecting health care services. Health policies with copayment provisions tend to be more affordable since they lessen the insurer's responsibility by splitting losses between the insured and the insurer.
What is Copay in Health Insurance?
Copay is a form of cost-sharing in health insurance plans in India. It is a fixed amount that the insured has to pay out of pocket for a covered health care service, typically at the time of service. Copays are usually fixed, although some insurance plans may have different copay amounts for different services. It can range from a few hundred to thousands of rupees, depending on the plan and the service.
Copay allows the insured to pay a fixed amount at the point of service. This amount is usually a percentage of the total cost of the service. The health insurance company then pays the remaining amount. For example, if a doctor's consultation costs Rs. 500, the insured may pay Rs. 200 as the copay. The health insurance company will pay the remaining Rs. 300.
It can help the insured manage their health care costs by allowing them to pay a fixed amount at the time of service while the insurer pays the rest. It helps to keep healthcare costs more affordable, which can be particularly beneficial for those with limited budgets.
Features of Copayment in Health Insurance
Niva Bupa is an excellent option to get your health plan. The following points should be considered to comprehend copayment and its features better:
The copayment percentage is predetermined when you buy a health plan with a copayment component.
Your insurer will reimburse the remaining costs for healthcare once you pay a portion of them.
Although the terms "copay" and "coinsurance" are sometimes used interchangeably, they have different meanings in India.
More significant copay percentages benefit insurers, but insured people might use them to benefit from cheaper premiums.
In India, many senior citizen health plans include copayment clauses.
Copay Clause: Advantages & Disadvantages
There are many advantages of Copay insurance which can be taken into account for buying it. Some of them are:
Reduced Policy Premium
A health plan that allows copayments can be purchased for a reduced policy premium. This occurs because the copayment enables you to share the insurance company's obligation, which allows them to charge you a reduced rate. Therefore, the premium amount will be lower the more significant the copayment.
Filing Minor Claims
Copay prevents many people from submitting needless health claims because it asks them to pay a percentage of their claims. You are aware that the insurer will charge you if you submit a claim for a simple ailment like a common cold or fever that can be treated at home, or for diarrhoea, for example. It also needs paperwork and verification, which deters people from making small claims.
Disadvantages
Copayments have the drawback that you cannot use your insurance policy to get adequate healthcare without contributing to the cost. With copayment, fewer unnecessary claims are made since policyholders are less likely to want to submit claims for every little medical procedure they get. However, the policyholder will eventually pay more toward the costs of the treatment rather than saving money on the premium amount, even when a more significant copay amount results in a lower premium.
Copay clauses in health insurance plans and products are typically less well-liked and less likely to be purchased. Therefore, individuals unaware of copay and coinsurance would select coverage without these provisions. Because of this, insurance that offers to cover all medical costs will have better goods and more customers.
A lower premium is the outcome of a higher copay. Again, this is accurate, but only to the degree that you, the insured, are exempt from using the cash value of your insurance plan. But if something does occur, you'll still need to use the money you saved on premiums to cover the cost of any necessary medical care.
Types of Copayment Clauses in Health Policy
Copayment clauses are categorised on the following basis:
To pay for medical expenses: Whether or not these costs are voluntary, this copay clause takes effect whenever you submit a claim for medical expenses or invoices. This means that while your insurance will cover the remaining costs of the claim, you are still responsible for a portion.
On being hospitalised: You will be required to pay a share of the claim if you are hospitalised in a big city. This is due to the higher cost of hospitalisation in metro areas compared to smaller towns.
On best health insurance for senior citizens: As the expense of healthcare for seniors is higher than that for younger people, this type of clause is typically required in medical insurance plans.
On claims for reimbursement: Copay requirements for reimbursement claims are included in several health plans. This provision takes effect when a payment is made to a hospital that isn't included in your insurer's network.
Importance of Copay in Health Plan
It promotes the ethical and responsible use of health policies. Because a copayment requires you to pay a portion of the cost out of your pocket, you will likely view your hospital stay or medical care as an additional expense. This will guarantee proper use because it instils a sense of ownership in you.
Additionally, it reduces risk and responsibility for the insurer. Large enterprises with enormous profit and loss statements are insurance companies. Payments made due to claims raise the balance in the loss column. The insurance provider directly saves 10% when all of its plans include a 10% copay (or coinsurance) clause.
Impact of Copay on Medical Insurance Premium
The percentage you split with your insurer directly affects the price of the premium. The copay system has significantly impacted health premiums, allowing providers to offer more affordable coverage. A copay is an out-of-pocket cost that must be paid each time a person visits a doctor or receives medical care. By requiring patients to pay a portion of their medical bills, copay helps to offset the cost of medical insurance premiums for both the provider and the consumer. Copay can affect the premium of your health plan in the following ways. For example:
Copay can help lower health premiums by reducing the claims insurers need to pay.
It can help to decrease the amount of unnecessary medical care and tests that are being done as it requires the patient to pay a portion of the cost upfront.
It can encourage people to think twice before seeking medical care, as they are responsible for a portion of the cost.
It can reduce administrative costs associated with insurance processing, as the insurer may not need to review the claims as thoroughly.
Copay can also help to ensure that people are more informed about healthcare costs and are more likely to shop around for more affordable care.
Difference between Copay & Deductible
Why Include Copay Clause in Health Insurance
Copay in health plans discourages people from filing frivolous claims because they will be responsible for some of the cost. The insurance company could be taxed back for claims for prescription drugs and other treatments used to treat the common cold or some type of ongoing gastrointestinal trouble. This leads to a limited claim amount and much pointless paperwork for both parties. Copays deter people from abusing their medical insurance coverage.
Things to Consider Before Buying Medical Insurance with Copay Clause
Although the copayment provision in your health policy could seem inexpensive, it's crucial to consider your needs before making a choice. Before selecting a plan with copay alternatives, you must ensure you have enough money to pay for your share of the hospitalisation expenditures.
Although copay clauses in health insurance plans may seem like a great idea, they do not significantly lower financial obligations in the event of medical crises. Therefore, it is advised that you select a health plan without a copayment clause if you are not prepared for the potential terms and circumstances that come with one.
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Vippan Kapur
It is unbelievable how Niva Bupa claim team came to my aid, Monday to Sunday no day off.
Meenakshi Khanna
Within few hours we got the claim number and in the next three days the amount was reflected in our bank account.
Vijay Kapoor
With the help of Niva Bupa Health Insurance, I was able to get my son treated without worrying about the high medical cost.
Diviay Chadha
Whenever we have filed for a claim with Niva Bupa, the process was very smooth and people were very helpful.
Parveen Singh
The Niva Bupa team was extremely helpful, be it day or night, someone was always available.
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