Co-payment is a cost-sharing arrangement between policy owners and insurers, where both parties split the cost of medical services.

i) Deductible: You make an initial payment for your medical care before your insurance coverage kicks in.

ii) Co-insurance: You pay a percentage of medical expenses and your insurance plan covers the remaining amount.

How can I make a co-payment claim?

Let’s say my insurance policy stipulates a 20% co-payment and I have to undergo a surgery that costs RM20,000. How will my portion (RM4,000) of the co-payment be collected?

Why co-payment?

Co-payment allows insurers to offer lower premiums because policy owners are sharing the cost of medical services. This discourages them from unnecessary or excessive claims, ensuring that their plan remains sustainable in the long run.

Who should consider a co-payment plan?

• Individuals or families on a tight budget: Co-payment plans are usually more affordable than full medical plans.
• Someone with good health who occasionally requires medical attention: The savings from lower premium can outweigh the occasional co-payment for medical expenses.
• Someone with an employee benefit plan: The co-payment amount can be covered by the employee benefit plan.

“Shouldn’t I opt for a full medical and health plan since it covers all costs?”

Full coverage medical and health plans are important in view of the rising medical costs every year. However, these plans are usually tied to higher premiums.

This means that you are paying more every month, regardless of whether you need medical care or not. For individuals who are generally healthy, you may end up paying more when you choose a full medical and health plan instead of a co-payment plan.

“Do I need to make a co-payment for each visit or service?”

Generally, policy owners need to make a co-payment for each visit or service they receive. However, there is often a maximum co-payment limit.

What is the annual limit of co-payments that policy owners are obligated to make?

Most medical and health insurance plans include a maximum out-of-pocket limit for each illness diagnosed (disability) or visit. Once this limit is reached, the insurance company covers 100% of the covered costs.

“How can I dispute a co-payment charge if I believe it is incorrect?”

These are common ways to dispute a co-payment charge if you believe it is incorrect:

1. Prepare all relevant information and documents to support your dispute.
2. Contact your insurer for clarification and corrective action.