Understanding co-insurance: what is it, and how does it work?

What is co-insurance?

Broadly speaking, co-insurance is a mechanism where you will need to pay a certain percentage of the total expenses covered by your insurance policy. This is similar, but different to a co-pay, as the costs of co-pay are a fixed amount instead of a percentage of the total covered costs.

When it comes to international health insurance plans, co-insurance may be a built in part of the plan or it might be an option you can take to can help reduce your premium. It’s a good idea to check the policy documents before taking out a health insurance policy to see whether co-insurance is optional or required, and also to be clear what it applies to.

For APRIL International’s MyHEALTH plans in Asia, we offer a 20% co-insurance option under the outpatient module, sometimes referred to as an 80/20 plan. By selecting the outpatient co-insurance option on our plans, you will enjoy a substantial deduction in your premium.

If you are interested in other ways to reduce your annual premium with APRIL International, be sure to read our article about deductibles, another premium saving option, which applies to the hospitalisation and surgery benefits.

How does co-insurance work under your MyHEALTH plan?

If you have chosen co-insurance for your MyHEALTH policy and you seek outpatient treatment, you will need to first pay for the total cost of the treatment and then submit a claim to us afterwards.

Once you’ve submitted your claim, it will be processed and 80% of the total covered medical expenses will be refunded.

For example:

If you visit a doctor and receive a total bill of $120, $100 for the consultation and $20 for the medicines & drugs, this is how the co-insurance would break down:

As an important side note, co-insurance does not apply to everything covered by the outpatient benefits. For example, co-insurance does not apply to benefits like medical check-ups and vaccinations. If you have selected maternity, or dental & optical modules as part of your coverage, co-insurance will also not be applied.

What does co-insurance apply to?

On our MyHEALTH plans, co-insurance only applies to treatments that fall under your plan’s outpatient benefits. In general, it is applied on consultations with general practitioners or specialists, medications, diagnostic scans and tests as well as others medical services which falls under the outpatient benefit.

You are always encourage to check on your plan’s benefits schedule to have a better understanding on what medical services co-insurance will apply to.

Can I access direct billing if I have co-insurance?

While you will have to pay and claim in most cases if you choose to take co-insurance as a premium reduction option, there are cases where you can use our direct billing services to make life more convenient.

Although members with co-insurance cannot access our broader Asia-wide direct billing network, however there is a good news as we do have special panel networks in Hong Kong and Singapore. In these panel networks, the 20% co-insurance for outpatient benefits is completely waived meaning that members with co-insurance on their outpatient module can use the direct billing services when seeking treatment at these panel network facilities.

The list of panel network facilities is available on our website via the customer portal. If you are already an APRIL member, you can also search for providers that are part of the panel networks on your Easy Claim app.

Explore your international health insurance options

With APRIL International’s MyHEALTH plans in Asia, you have incredible freedom in customising your own health insurance plan. You can optionally choose to add outpatient, maternity or dental & optical benefit modules onto your hospitalisation and surgery coverage, as well as choosing the level of coverage for each module independently.

If you’re not sure about what benefits will best suit the protection requirements of yourself, your family or business, you are welcome to contact us today and our staff will be happy to assist you.

Plans for individuals and families

MyHEALTH is our plan for individuals and families; its flexibility allows you to get the right level of protection at a reasonable price.

> Learn more about our international coverage options in Asia

Off-the-shelf group health insurance plans

Perfect for SMEs, our MyHEALTH Business plans offer flexibility without the fuss, making it easy to offer attractive employee health benefits within your budget:

> Learn more about MyHEALTH Business for groups

Fully tailorable group health insurance plans

Perfect for corporations that may need to cover a substantial number of employees at different levels, or spread across offices through the region, YourHEALTH Benefits offers fully tailorable options.

> Learn more about your company’s options with YourHEALTH Benefits