10% co-payment on health insurance from 2027? What insurers have proposed and what IRDAI said
Insurers are weighing a compulsory 10% co-payment on retail health claims from 1 January 2027. It is only a proposal. What it would mean and what IRDAI said.
You may have seen headlines saying that from 2027 you will have to pay 10% of every hospital bill even if you have health insurance. That is a proposal from insurers, not a rule. Here is what was reported, what the insurance regulator said, and what it would mean if it did go through.
What was proposed
The Times of India reported on 4 October 2026 that general insurers, through their industry body the General Insurance Council, are considering a compulsory 10% co-payment on retail health insurance claims from 1 January 2027. Under the proposal as reported:
- You would pay 10% of the admissible amount of every hospitalisation claim, cashless or reimbursement, including accidents.
- Your share would be capped at ₹5 lakh per claim.
- It would cover individual and family indemnity policies, retail policies sold through groups, the indemnity part of combi products, and policies that are migrated or ported.
- Outpatient claims would stay outside it.
- You could not remove it with a rider, and could not claim the 10% from another health policy.
- In return, insurers say annual premiums would be lower.
The proposal comes with a plan for a common list of hospitals with standard package rates and a formal way to settle disputes between insurers and hospitals.
What IRDAI said
Any change across the whole industry needs approval from the Insurance Regulatory and Development Authority of India (IRDAI). Its chairman, Ajay Seth, said on 11 October 2026 that the co-payment idea had not yet reached the regulator. He said a co-payment without a cut in premium is something "nobody is agreeing on", and that its safeguards and effect on premiums have to be studied first, as reported by The Insurance Reporter. Moneycontrol reported on 8 October that industry executives think a uniform rule could face regulatory hurdles and may not go ahead in its current form.
So for now, nothing has changed. Your policy keeps the terms it was sold with.
What it would cost you
The 10% applies to the admissible part of the bill, after items your policy does not pay for, such as some consumables. Moneycontrol's example: on a ₹5 lakh hospital bill with ₹1 lakh of items not covered, the admissible claim is ₹4 lakh. You would pay ₹40,000 as co-payment plus the ₹1 lakh not covered, ₹1.4 lakh in all, instead of ₹1 lakh today.
Co-payment already exists in some policies
Some policies already have a co-payment, by choice or by design. Arogya Sanjeevani, the standard policy every insurer must offer, has a 5% co-payment. Many senior citizen policies have one too, and some policies apply it when you are treated in a costlier city than the one your premium is based on. What is new here is making it compulsory on every retail policy.
What you can do now
- Check your policy schedule for any existing co-payment, room rent limit or sub-limits.
- Do not cancel or switch a policy because of this proposal. If you port later, your waiting periods carry over, but read the new terms.
- Keep some emergency savings for hospital costs your policy does not pay, whatever happens to this proposal.
We will update this page if IRDAI issues a draft rule.
Sources: The Times of India: Insurance companies want policyholders to pay 10% of health claims, The Insurance Reporter: IRDAI chief says 10% health co-pay yet to reach regulator, Moneycontrol: What a proposed 10% co-payment means for health insurers, The Hindu BusinessLine: Interview with IRDAI Chairman Ajay Seth.
Rules, rates and limits change. Check the official source linked above before you rely on a figure here. Posts never contain referral or affiliate links from the writer.
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