Don’t be con­fused about these terms

Consumer Voice - - BFSI -

• De­ductibles

Top-up plans work on a cost-shar­ing ba­sis where med­i­cal ex­penses up to the de­ductible limit have to be borne by the pol­i­cy­holder. In or­der to pay the de­ductible amount, the in­sured can ei­ther use the sum in­sured from an ex­ist­ing health plan or con­trib­ute from their own pocket. The in­sur­ance com­pany bears the med­i­cal cost only if the ex­penses cross the de­ductible limit.

A de­ductible does not re­duce the sum in­sured. It means the amount of hos­pi­tal­i­sa­tion ex­penses that you need to bear be­fore the pol­icy starts pay­ing. You can opt for a limit that suits your pocket; the in­sur­ance provider will not pay you up to the de­ductible limit cho­sen by you.

There­fore, if you al­ready have a health plan of Rs 2 lakh, you can opt for a top-up pol­icy of Rs 5 lakh with Rs 2 lakh as de­ductible. It means that the ini­tial Rs 2 lakh will have been paid by your ex­ist­ing medi­claim and the re­main­ing Rs 3 lakh will be borne by the top-up plan.

• Thresh­old limit

It is the level up to which your ex­ist­ing health-in­sur­ance pol­icy cov­ers hos­pi­tal­i­sa­tion ex­penses. Be­yond this level, the li­a­bil­ity to pro­vide med­i­cal cover lies with the in­sur­ance com­pany that has pro­vided you a top-up plan.

• Co-pay

It refers to the amount ex­pected to be paid by you for med­i­cal ser­vices cov­ered by the plan. In other words, co-pay means con­cur­rent li­a­bil­ity to pay a cer­tain amount of your own con­tri­bu­tion on a health pol­icy to avail the health ben­e­fit up to the sum as­sured, sub­ject to the type of pol­icy or age re­stric­tion or other con­di­tions en­shrined in the pol­icy. This is al­ways at a cer­tain per­cent­age of the sum as­sured.

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