Insurers Demand Patients Pay 10% of Medical Bills

The General Insurance Council (GIC) has proposed a significant change to health insurance policies in India, mandating a 10% co-payment on treatment costs for all policyholders starting January 1, 2027. This move, intended to control escalating healthcare expenditures, suggests that patients will be responsible for a portion of their medical bills, even with comprehensive coverage.

While insurers cite inflated hospital charges and unnecessary treatments as reasons for the proposal, concerns are mounting over the potential financial strain on patients. The proposed ₹5 lakh cap on patient contribution could still leave individuals with substantial out-of-pocket expenses, particularly in cases of severe accidents or prolonged illnesses, as the average claim amount is considerably lower. This could potentially replicate negative outcomes seen in past international studies where increased patient costs led to delayed treatments and reduced care.

Regulators, including the Insurance Regulatory and Development Authority of India (Irdai) and the Competition Commission of India (CCI), are called upon to scrutinize the proposal. Critics question why patients should bear the costs of systemic issues like arbitrary hospital pricing, suggesting insurers should leverage their bargaining power to address these problems directly. The GIC's fixed timeline for co-payment implementation, contrasted with the indefinite status of measures addressing fair hospital pricing, also draws criticism.