NISM Certifications · NISM-Series-X-B: Investment Adviser (Level 2) · Non-Life Insurance Products
Mr. Raman Iyer has a health policy with a sum insured of ₹10 lakh that carries a 20% co-payment on every claim. He incurs admissible hospital expenses of ₹4,00,000, all within sub-limits. How much will the insurer pay?
The insurer pays ₹3,20,000. A 20% co-payment makes the insured bear ₹80,000 of the ₹4,00,000 admissible claim, and the insurer pays the remaining 80%. The sum insured of ₹10 lakh is not exceeded, so no further limit applies.
- A₹3,20,000Correct
- B₹80,000
- C₹4,00,000
- D₹2,00,000
Explanation
Co-payment of 20% means the insured bears 20% of the admissible claim: 20% x 4,00,000 = 80,000. The insurer pays 4,00,000 - 80,000 = 3,20,000. The ₹80,000 option is the amount borne by the insured, not paid by the insurer.
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