In health insurance, copayment is fixed while co-insurance is the percentage that the insured pays after the insurance policy's deductible is exceeded, up to the policy's stop loss. It can be expressed as a pair of percentages with the insurer's portion stated first, or just a single percentage showing what the insured pays. Once the insured's out-of-pocket expenses equal the stop loss the insurer will assume responsibility for 100% of any additional costs. 70–30, 80–20, and 90–10 insurer-insured co-insurance schemes are common, with stop loss limits of $1,000 to $3,000 after which the insurer covers all expenses.
Co-insurance is a penalty imposed on the insured by the insurance carrier for underreporting, declaring, or insuring the value of the tangible property or business income. It also applies without a concealment for the insured to bear some sort of responsibility and thus reduce moral hazard. The penalty is based on a percentage stated within the policy and the amount underreported. As an example: A buildings replacement cost actually valued at $1,000,000 has an 80% co-insurance clause but is insured for only $750,000. Since its insured value is less than 80% of its replacement value, when it suffers a loss, the insurance payout will be subject to the underreporting penalty. For example, if it suffers a $200,000 loss, the insured would recover $750,000 ÷ × 200,000 = $187,500. In this example, the underreporting penalty would be $12,500. More generally, suppose a building with replacement cost R is insured for amount I, with a co-insurance requirement c, expressed as a number between 0 and 1. If this building suffers a loss L, then the insurance payout would be the smallest of the three amounts, L, I, and IL/. The first two alternatives reflect the fact that the payout will not exceed the loss nor the amount the building was insured for, while the last amount represents the intended action of the co-insurance requirement to penalize underreporting. The most commonly issued co-insurance percentage would be 80% but it can be as high as 100%, which would impose the greatest penalty for underreporting. For this reason, it is vital for values of the property to be accurately reported and updated annually to reflect inflation and other increases in cost...
In title insurance
Owner's title insurance policy forms of the American Land Title Association created between 1987 and late 2006, contain co-insurance clauses. For partial losses, they require the insured carry a percentage of the risk of loss in two circumstances. The first is if the insured did not insure its title for at least 80% of its market value at the time the policy was issued. In that case, the insurer will pay only 80% of the loss. The second is if improvements constructed on the property after the policy is issued increase the property's value by at least 20% above the amount of the policy. In that case, the insurer will pay a percentage of the claim equal to the ratio of 120% of the amount of insurance purchased divided bythe sum of the amount of insurance and the cost of the improvements. Co-insurance is also used among U.S. domestic title insurers in a manner similar to that described below for the international insurance market.
In other insurance
In some cases, including employer's liability insurance, co-insurance percent denotes a function analogous to the copay function that it has in health insurance, in which the insured covers a certain percentage of the losses up to a certain level. In business income interruption insurance, a type of time-element insurance, the co-insurance percent indicates how long the coverage will last, and can range from 50% to 125%. The former co-insurance allows for 6 months of coverage, compared to 15 months for 125%.
In Europe
In the international insurance market, co-insurance is the joint assumption of risk between various insurers. Co-insurance is generally widely used in the European insurance market. In this context, a common insurance contract is used and the risk is shared based on percentages between the insurance companies. Often, one insurance company will lead. When leading the insurance company will be responsible for administering various aspects of the insurance policy, such as premium, any claims and the insurance documents. In this situation, a charge is levied.
