COINSURANCE
The percentage of covered healthcare costs you pay after meeting your deductible, while your health plan pays the remaining share.
Glossary of Terms
Benefits terminology and definitions.
Glossary of Terms
Video coming soon
COPAYMENT
A copayment (copay) is the fixed dollar amount you pay for certain in-network services on a PPO-type plan. In some cases, you may be responsible for coinsurance after a copay is made.
DEDUCTIBLE
A deductible is the amount of money you must meet before your plan begins paying for services covered by coinsurance. Some services, such as office visits that require copays, do not apply to the deductible. For example, if your plan’s deductible is $1,000, you’ll pay 100 percent of eligible healthcare expenses until you have met the $1,000 deductible. After that, you share the cost with your plan by paying coinsurance.
FORMULARY
A list of prescription drugs covered by the plan. Also called a drug list.
GUARANTEED ISSUE (GI)
The amount of insurance coverage you can elect without providing medical evidence or answering health questions.
HIGH-DEDUCTIBLE HEALTH PLAN (HDHP)
This type of medical plan requires that members reach a deductible prior to having services covered by coinsurance. All expenses paid by a member count toward the deductible and out-of-pocket maximum.
IN-NETWORK
A group of doctors, clinics, hospitals, and other healthcare providers that have an agreement with your medical plan provider. You pay a negotiated rate for services when you use in-network providers.
OUT-OF-NETWORK
Care received from a doctor, hospital, or other provider not part of the plan agreement. You’ll pay more when you use out-of-network providers since they don’t have a negotiated rate with your plan provider. You may also be billed the difference between what the out-of-network provider charges for services and what the plan provider pays.
OUT-OF-POCKET MAXIMUM
This is the most you must pay for covered services in a plan year. After you spend this amount on deductibles and coinsurance, your health plan pays 100 percent of the costs of covered benefits. However, you must pay for certain out-of-network charges above reasonable and customary amounts.