Insurance companies want policyholders to pay 10% of health claims

Mumbai: Non-life insurers are contemplating a 10% co-payment by policyholders on retail health policies starting January 1, 2027, with the patient's contribution limited to Rs 5 lakh per claim. In exchange, customers would pay lower annual premiums. The proposal, under consideration by the General Insurance Council, would accompany common hospital empanelment and a formal dispute resolution mechanism.

Even those with comprehensive health insurance would need to fund medical emergencies, paying 10% of inpatient hospitalization costs, including those resulting from accidents, regardless of whether claims are processed through cashless procedures or reimbursements. Outpatient claims would not be subject to this scheme. The co-payment is non-negotiable, unchangeable through riders or endorsements, and cannot be recovered from another health insurance policy.

Health insurance expert Shreeraj Deshpande stated that the choice between a cheaper policy with a deductible and a comprehensive policy should be the insured's decision. Industry insiders warn that a mandatory requirement could be anti-competitive, potentially drawing the Competition Commission's attention. The measure aims to curb cost distortions in healthcare and providers' incentive to order unnecessary tests, recommend procedures, and extend hospital stays due to comprehensive insurance coverage.