The 5 rupees is inclusive of taxes and stuff. Also there are no payment processing fees in India AFAIK. At the counter you can give a 5 rupee coin or pay 5 rupees via UPI or card, and you get a receipt and token number. But paying for the medicines and public transport would cost extra, so you would be spending almost ₹100 (or even ₹200 if expensive antibiotics are involved) by the time you reach home.

Edit: this is only for regular illness such as the flu or COVID, and most people wouldn't use life/health insurance for that. Doing surgeries or therapy (which is still hard to find here) will cost a lot more, and insurance and stuff will likely complicate things.