Let’s take a drive in this topic about Deductible and how it works in Insured’s Health Insurance.
Meaning of Deductible: Deductible is a fixed amount you must pay out of your own pocket before the insurance company starts paying a single rupee. Once Policyholder pay’s and then only he can use his Health Insurance. Deductible is usually selected to reduce the premium and to make policies little attractive.
Earlier this was found in Top Up, Super Top Up policies but now you can take this in your Base sum insured too. Deductible range starts from 10k till 10 lacs. Buying policy with 25k deductible can decrease the premium till 25%.
Feature | The Positive (+ve) | The Negative (-ve) |
Premium Cost | Lower Premiums: Policies with high deductibles are much cheaper. It’s great for “Top-up” plans to increase cover at a low cost. | Out-of-Pocket Expense: You must have the deductible amount ready in cash before the insurer honors the claim. |
Claim Frequency | Prevents Small Claims: It keeps your No Claim Bonus (NCB) intact by discouraging you from claiming for minor issues. | Financial Barrier: It might make you hesitate to go to the hospital for necessary but “small” treatments because you have to pay. |
Total Coverage | High Cover for Cheap: You can get a massive ₹50 Lakh cover for a very small price if you agree to a ₹5 Lakh deductible. | The “Waiting” Gap: If your hospital bill is lower than the deductible, the insurance company pays ₹0. |
How to Manage a Deductible During Claim Lodging
When you are at the hospital billing desk, managing a deductible requires clear communication to avoid “billing shocks.”
- Check the Threshold:Before admission, confirm your deductible amount (e.g., ₹50,000).
- The Base Policy Rule:If you have a “Base Policy” (Policy A) and a “Top-up with Deductible” (Policy B), use Policy A to pay the deductible of Policy B.
- Cashless Process:Tell the TPA (Third Party Administrator) clearly: “I have a deductible of ₹X. I will pay that via my base policy/cash, please process the rest as cashless.”
- Collect All Original Bills:Even if the insurance company doesn’t pay the first part, you need the hospital to give you a “Settlement Letter” showing that the deductible was met.
Conclusion All over deductible is a good tool to reduce the premium, if policyholder choose by himself and aware of the same while taking claim. Also need to note if small claim raises then he can bear it from his pocket or if the huge claim rejects, then he has to pay entire bill amount and later can take reimbursement from Insurer or if consecutively claim arise then he has to manage this every year.
Difference in the premium after applying Deductible
