Mandatory Co-Pay: Your Health Claim Just Got Costlier?

Health insurers may soon make co-payment mandatory for all policyholders. This means you pay a fixed percentage of every hospital bill yourself, even after paying annual premiums. Premiums may fall slightly, but your out-of-pocket costs during illness could rise sharply.

Here's what happened: Industry experts and regulators are actively discussing making co-payment a standard, mandatory feature in Indian health insurance policies rather than an optional add-on.. Under a mandatory co-pay structure, policyholders would bear a fixed percentage — typically 10% to 30% — of every hospitalisation bill directly from their own pocket at the time of claim.. The proposed rationale is to curb over-hospitalisation and inflated medical bills, with insurers suggesting premiums could be reduced in exchange for the shared cost burden on policyholders..

What you should do: Check your current health policy document right now for any existing co-pay clause — look under 'terms and conditions' or 'cost-sharing'; if absent, you have zero co-pay today.. Calculate your real exposure: multiply your sum insured by 20% and check if your emergency savings can cover that gap — if not, build a dedicated medical buffer fund of at least ₹1–2 lakh.. At your next renewal, compare plans carefully on co-pay terms, not just premium — a policy with zero co-pay and slightly higher premium often delivers better value during a major hospitalisation..

Many 'top-up' or 'super top-up' health plans have zero co-pay clauses even today — pairing one with your existing base policy can protect you from any mandatory co-pay exposure on large claims.

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