Discover a clear glossary of insurance terms, including cash value, pre-existing condition, premium holiday, and more.
Amount payable in insurance is the amount paid by the insurance company to the policyholder or hospital when a claim is approved. In health insurance, this term relates to claims, deductibles, and benefit limits that determine the amount of coverage.
For a more complete explanation, you can also check the full list of insurance terms.
Amount payable appears explicitly in the insurance policy document as a form of responsibility from the insurance company when the insured risk actually occurs. The amount is determined based on the type of coverage, claim requirements, and agreed limit.
In a reimbursement scheme, the amount payable is paid to the policyholder after submitting proof of medical payment. Meanwhile, in a cashless system, the company pays directly to the partner hospital. This is where the importance of choosing a policy with a wide hospital network comes in.
For example, a patient undergoes hospitalization with a total bill of Rp30 million. If the health insurance covers Rp25 million and the rest is paid by the patient, then the amount payable is Rp25 million.
In a cashless system, the patient only needs to show the insurance card, and the hospital will bill the company directly. Meanwhile, in a reimbursement system, the patient pays first, then submits a claim.
Learn more about the benefits of cashless health insurance to avoid the hassle of upfront payment.
Amount payable becomes the main indicator of how much the company is responsible for in a claim. The larger this amount, the better the protection received by the policyholder.
However, this amount may vary depending on policy terms and whether a deductible or co-payment applies. Therefore, it is very important to understand the claim procedure correctly.
Amount payable is paid by the insurance company when a claim is approved and its value reflects the financial obligation borne by the insurer in accordance with policy provisions. Meanwhile, the insurance term deductible is a fixed amount that must be paid by the policyholder personally before the insurance company starts covering the remaining medical costs.
On the other hand, co-payment is a certain percentage of the total medical cost that still has to be paid by the policyholder even though they already have insurance, usually ranging from 10% to 30%.
Although often misunderstood and considered similar, the three have very different roles in the protection structure and the time of their application in the claim process. Understanding these differences is very important so that insurance holders do not misinterpret the benefits they have.
Many insurance policyholders mistakenly assume that all hospital expenses will be fully covered by insurance unconditionally. In reality, there are several limitations and provisions that may restrict the amount paid by the insurance company or the amount payable.
There is a benefit ceiling or annual limit that caps the maximum amount that can be covered by insurance during one policy year.
There are specific medical exclusions that are explicitly not covered by the policy, such as congenital diseases, pre-existing conditions, or treatments that do not comply with provisions.
There is a possibility that co-payment applies, where the policyholder must still bear part of the medical costs even though they are insured.
Misunderstanding amount payable can lead to confusion during the claim process, financial unpreparedness, or even denial of reimbursement by the insurer. Therefore, it is important for policyholders to read the policy thoroughly and understand all the terms and provisions.
Understanding terms such as amount payable helps you choose a health insurance product that suits your needs and financial situation. Choose the best health insurance so that you get maximum protection without confusion when filing a claim.
If you want to get other interesting information about insurance, you can visit the Roojai website.