Choosing the right health insurance policy involves more than comparing premiums and coverage amounts. Policyholders should also understand cost-sharing terms such as deductibles and co-payments, as these determine how much they may need to pay out of pocket when making a claim.
Although both terms refer to expenses that the insured may have to bear, they work differently. Understanding the difference between a deductible and a co-payment can help you compare policies, estimate potential medical expenses and select coverage that suits your financial needs.
A deductible is a specified amount that the policyholder must pay before the insurer starts covering expenses to which the deductible applies. The deductible amount and its applicability are defined in the policy terms.
When a claim is made, the deductible is applied according to the policy conditions. The insurer pays eligible expenses above the applicable deductible, subject to the sum insured, exclusions and other limits.
For example, if a policy has a ₹20,000 deductible and the admissible hospital bill is ₹1 lakh, the policyholder generally bears the first ₹20,000. The insurer may cover the remaining ₹80,000, provided the expenses are eligible, and no other limits apply.
A fixed deductible is expressed as a specific monetary amount. It may apply per claim, per policy year or under another arrangement specified in the policy.
Before buying a policy, check whether the deductible applies to every claim or only to particular benefits. Also, confirm whether other cost-sharing conditions apply after the deductible is met.
A co-payment, commonly called a co-pay, is the percentage of an admissible medical claim that the policyholder must pay. The insurer pays the remaining eligible amount, subject to the policy's terms, coverage limits and exclusions.
Unlike a deductible, which applies to a specified amount, a co-payment is calculated as a percentage of the admissible claim.
For example, if the admissible claim is ₹1 lakh and the co-payment is 10%, the policyholder pays ₹10,000, while the insurer pays ₹90,000, subject to applicable conditions.
A co-payment may be mandatory under certain policies or apply when specific conditions are met. These can include:
Always check when the co-payment applies and whether it is calculated before or after other applicable deductions.
The main difference is how the policyholder's share is calculated.
| Feature | Deductible | Co-payment |
| Calculation | Fixed monetary amount or specified threshold | Percentage of the admissible claim |
| When it applies | Before applicable insurance benefits become payable | On the admissible claim as specified in the policy |
| Policyholder's expense | Pays the applicable deductible | Pays the specified percentage |
| Effect on premium | May reduce premiums under certain options | May reduce premiums under certain options |
| Key consideration | Can be significant for smaller claims | Increases the insured's contribution to each applicable claim |
A deductible is based on a specified amount, whereas a co-payment is calculated as a percentage. The exact calculation depends on the policy's terms.
A policy may include both provisions. In that case, check the order in which they apply and whether other limits or exclusions affect the final claim settlement.
Before purchasing health insurance, review:
The following examples use hypothetical figures to explain the difference. Actual claim settlements depend on the policy terms and admissible expenses.
Assume a hospital bill of ₹1,50,000 is fully admissible, and the policy has a ₹25,000 deductible.
| Particular | Amount |
| Admissible hospital bill | ₹1,50,000 |
| Deductible paid by policyholder | ₹25,000 |
| Potential insurer payment | ₹1,25,000 |
The insurer may pay ₹1,25,000, provided the claim satisfies all policy conditions and no other deductions apply.
Assume the admissible hospital bill is ₹1,50,000 and the policy has a 20% co-payment.
| Particular | Amount |
| Admissible hospital bill | ₹1,50,000 |
| Policyholder's 20% share | ₹30,000 |
| Potential insurer payment | ₹1,20,000 |
Here, the policyholder pays ₹30,000. The percentage-based contribution differs from the fixed amount payable under a deductible.
Policies with deductibles or co-payments may offer lower premiums because the policyholder agrees to bear part of the eligible expenses. However, the actual premium benefit depends on the insurer, selected option and underwriting terms.
Consider these points:
Choose terms that match your financial circumstances. If your emergency savings are limited, a policy with a high deductible may create difficulties during hospitalisation. Review your likely expenses before accepting a lower premium in exchange for higher cost-sharing.
The policy wording and Customer Information Sheet (CIS) explain important coverage conditions. The Insurance Regulatory and Development Authority of India (IRDAI) recommends checking deductibles, co-payments, exclusions, sub-limits and network hospital availability before purchasing a policy.
Estimate how much you could pay for different hospital bills under each policy option. Compare the annual premium, deductible, co-payment and other potential non-payable expenses to understand the overall financial commitment.
ManipalCigna Infinix offers hospitalisation coverage with individual and family floater options, making it a flexible family health insurance choice. Sum insured options include ₹10 lakh and unlimited coverage, subject to the selected variant and policy terms.
Key features include:
Review the latest ManipalCigna Infinix policy wording and product brochure to understand how each deductible option works, whether any co-payment applies and how these terms affect your claim. Select an option based on your healthcare needs and ability to manage out-of-pocket expenses.
A deductible is a specified amount or threshold, while a co-payment is a percentage of the admissible claim. Confusing them can lead to incorrect estimates of personal expenses.
Do not assume the deductible applies only once or that a co-payment applies to every claim. Check the applicable calculation method, policy period and circumstances in which each condition is triggered.
A low premium should not be the only deciding factor. Estimate your share under different claim scenarios and ensure you can afford it without disrupting essential financial commitments.
Understanding deductible vs co-payment in health insurance helps you make a more informed decision. A deductible involves a specified amount, while a co-payment requires you to pay a percentage of the admissible claim.
Compare both provisions alongside premiums, coverage limits, exclusions and claim conditions. The right policy should offer suitable hospitalisation protection while keeping potential out-of-pocket expenses manageable.
A deductible is a specified amount the policyholder must bear before applicable insurance benefits become payable. Its calculation and applicability depend on the policy terms.
A deductible is a fixed monetary amount or threshold, while a co-payment is a percentage of the admissible claim. Both can affect the amount paid by the policyholder.
Not always. A higher deductible may reduce the premium under certain options, but the savings depend on the insurer and policy terms. Compare the premium reduction with the additional financial responsibility.
Yes. Some policies may include both. Check how each condition applies, the order of calculation and whether other limits affect the claim.
Review your policy wording, Customer Information Sheet (CIS), benefit schedule and applicable endorsements. Contact your insurer for clarification if the calculation or applicability is unclear.