What is Deductible in Health Insurance?

Insurance deductible refers to the amount of money you will pay for an insurance claim before the insurance coverage kicks in and the company starts paying you the health insurance sum insured or the coverage amount. The meaning of deductibles in health insurance might not be understandable for everyone. In this article, we will learn about the basics of deductibles in medical billing.

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    Here, you will learn about the basics of deductibles in medical insurance, their meaning, how it works, and how much does it cost.

    What is deductible in health insurance with example?

    Here is how it works - If your health insurance plan’s deductible amount is Rs 5,000 and the policy claim is Rs 40,000, then the health insurance company is only liable to pay Rs 40000- Rs 5000=Rs 35,000. The percentage of deductible i.e. Rs 5,000 will be paid by you as a part of the plan.

    Or say, for example, your medical claim is Rs 15,000 and your health insurance deductible amount is Rs 15,000, then the insurer is not bound to pay anything below the deductible limit.

    Your health insurance provider is only liable to pay the cost that exceeds the deductible amount.

    Still, confused? Understand it this way:

    The idea behind the deductibles imposed by all the insurance companies is to limit the policyholders from filing small claims. It makes them responsible for registering claims as they know in advance that a portion of the claim needs to be borne by them.

    The whole process keeps behind the unnecessary claim requests, and only genuine claims are filed. Therefore, it is imperative to understand the structure of deductibles under a health insurance plan before you make the purchase.

    What is Deductible in Top-up Health Insurance?

    Deductible in a top-up plan are common. It is the limit up to which the insurer will bear the healthcare costs and the remaining will be borne by the policyholder. A top-up plan medical insurance plan provides coverage above the existing coverage limit under the current health plan. 

    For example, you have a top-up health cover of Rs 10 lakh with a deductible of Rs 3 lakh, then you can use your base policy to pay Rs 3 lakh and the remaining 7 lakh will be covered under your top-up mediclaim policy.

    Types of Deductible in Health Insurance

    There are two deductible options that you get in health insurance:

    Compulsory Deductibles Voluntary Deductible
    This is an amount that the insurer that the policy holder will have to pay at the time of claim settlement It is the amount that the policyholder chooses to pay on his own at the time when a health insurance claim arises. The chosen deductible amount can vary from one policyholder to another as per their financial ability and the sum insured
    The premium remains the same as per the amount of compulsory deductible The premiums are lower if the deductible amount is higher
    When a claim is filed, the policyholder will only pay the compulsory deductibles as set by the Insurer When a claim is filed, the policyholder will only pay the chosen deductible amount as set by the Insurer

    Deductible vs. Copay Clause in Health Insurance

     Check out the below table for a comparison between Deductible and Co-pay:

    Parameters Co-pay Deductible
    Meaning Co-pay is the fixed portion of the amount that the policyholder needs to pay towards his treatment expenses and the rest is paid by the insurer.This can be paid as a fixed amount or a fixed percentage of the total treatment cost A deductible is the fixed amount that the insured has to bear before their health plan kicks in and covers the remaining portion of your total medical bill
    Example 10% of the surgery cost. Let’s say the cost of the surgery is Rs 1 lakh.The insured needs to pay Rs 10,000 as 10% of the total cost and the remaining 90,000 will be paid by the health insurance company. Here, the deductible is Rs. 6000 that the insured needs to pay towards the treatment.The insurer will contribute only after the insured has paid his/her share of Rs 6000.
    Applicability Co-payment is applicable only on specific medical services as mentioned in the policy wordings.   A deductible is applicable before the insurer settles the amount and the insured needs to pay the specific percentage of the treatment cost


    Whether you opt for a deductible or not your health insurance coverage depends on various factors like medical histories, present medical conditions, lifestyle, good physical condition, etc. Therefore, it makes sense to go through all the health insurance details and understand the terms before signing up for it. For any further queries, you can write to us at care@policybazaar.com and buy a policy with minimal deductibles. We will help you with the same from the comfort of your home!

    Written By: PolicyBazaar - Updated: 23 July 2021
    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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