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Query on Co-Payment
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01 Dec, 2021
by Rayapu Ashok Kumar Reddy
Dear Members
I have base policy of Rs.10 lakhs in Manipal Cigna company and super top up of Rs. 20 lakhs in care health. In care health there is a co-payment of 20% i need to pay on admisable medical expenses and in manipal cigna there is no co-payment.
My query is if i get hospitalised and the total admisable expense is 30 lakhs, how much co-payment should i pay. Will care health take co-payment 20% on it's policy sum insured of 20 Lakhs or will the company take the 20 % on total hopital admisable expenses of 30 lakhs ? including for the claim 10 lakhs settled by Manipal cigna company.
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03 Dec, 2021
Rayapu Ashok Kumar Reddy
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Care will charge a copay of 20% on the total amount that becomes due on Care.
Let's look at an example -
I am assuming the deductible in Care policy is 10 lacs. If the total hospital bill is 25 lacs, you can claim 10 lacs from Manipal Cigna. The balance 15 lacs can be filed with Care for reimbursement, out of which, Care will pay 80% and you shall pay 20%.
I have given a simple example. The settlement amount may slightly vary on account of non payable expenses.
Hope this is fine.
Asad