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Understanding Deductibles in Health Insurance

Understand what is deductible in health insurance with examples & select the right deductible amount for your health insurance policy. Learn more at ICICI Lombard.

  • 28 Apr 2022
  • min read

Deductibles in Health Insurance Plans

Having an insurance policy may not cover you entirely during a medical emergency. This is because of a mostly overlooked aspect of health insurance called deductibles. A health insurance deductible is the amount payable by the policyholder while raising a claim. This amount is predefined in the policy plan. For example, if you raise a claim of Rs 1 lakh and the deductible mentioned in the policy is Rs 40,000, the insurer will approve payment of Rs 60,000 only after adjusting the deductible amount. It is the amount that you need to pay before the insurer starts to pay against the claim. In other words, you must pay medical insurance deductibles out of your pocket.

Why are deductibles included in health plans?

Deductibles are included in health insurance policies to discourage policyholders from making trivial claims. This also ensures that people don’t misuse their health covers to avail of hospitalization for minor medical concerns.

Relation with health insurance premium

The risk burden of the insurer reduces when there is a deductible amount in the health insurance policy. Therefore, health policies with high deductibles amount generally have a low insurance premium amount. If the amount of the deductible is low or non-existent, the premium amount will be higher.

Types of health insurance deductibles

  • Policyholders can select voluntary deductibles amounts as per their budget and affordability. and decide their premium amount accordingly.
  • A compulsory deductible is pre-decided by the insurer at the time of policy purchase. While buying a health policy with a compulsory deductible, the deductible becomes just another point in the list of policy terms and conditions. The compulsory deductible doesn’t have any impact on the premium amount.
  • A cumulative deductible is applicable in family floater plans. In these policies, the insurance cover is a cumulative amount applicable to all the members of the family floater policy. Accordingly, the deductible amount is also applicable to all members cumulatively.
  • A comprehensive deductible keeps on adding till you pay the amount applicable in your health policy. It is a single deductible that applies to all health covers, but it is not available in India at present.
  • Non-comprehensive deductibles apply to specific parts of the policy and not the entire policy. Thus, it is deducted only when you raise a claim against such medical treatments to which the deductible is applicable. For any other claims, the deductibles clause is not triggered.

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Things to keep in mind

The applicability of the medical insurance deductibles and the payment terms are the two key factors that you must consider while buying a health cover. You must check the portions of the cover to which the deductible is applicable. Similarly, also find out the covers against which no deductible cover is required. For health deductibles payment, check how much you need to pay towards the health insurance deductibles and how often.

Difference between co-pay and deductibles

Co-payment is a predetermined and fixed amount paid by the policyholder each time a claim is made. While deductible is the amount that the policyholder pays before the insurer settles the claim, co-pay is a specific percentage of the claim that has to be paid by the policyholder. Nonetheless, both are expenses in the hands of the policyholder.

Why should you accept health insurance deductibles?

With deductibles, your propensity to raise claims is reduced, particularly the trivial ones. This protects your sum assured so that it can be used to the fullest if a significant medical emergency arrives. Raising no claims also earns you the No Claim Bonus, reducing your premium cost or considerably increasing your sum assured.

As mentioned earlier, the inclusion of a deductible also reduces your premium amount, so that you can buy a better health cover in the same budget.

One may note that the presence of deductibles means that you have to pay a portion of the hospital bill. In the case of smaller medical bills, you may end up paying most or all of it yourself. Nevertheless, medical insurance deductibles offer you the flexibility of rearranging your premium amount as per your affordability. A well-balanced health cover with your preferred deductible amount can safeguard you financially in your hour of need.

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