terms

TERMS

• Co-Insurance – Coinsurance is your share of the costs of

a covered service, calculated as a percent amount of the
allowed amount for service. For example, if the plan’s
allowed amount for an overnight hospital stay is $1,000,
your co-insurance payment of 20% would be $200. This
may change if you haven’t met your deductible.

• Copayment – Copayments are fixed dollar amounts (for

example $15) you pay for covered health care, usually
when you receive the service.

TERMS

• Deductible – You must pay all the costs up to the

deductible amount before the plan begins to pay for
covered services. Deductibles start over at the beginning
of each calendar year, January 1st. Some plans have a 4th
quarter carryover which means if you meet the deductible
in the 4th quarter of the calendar year (October, November,
December) it carries forward to the new calendar year.

• Maximum Out of Pocket – This is the maximum you

would pay our of your pocket during a plan year.

TERMS

• In Network – Providers that you can access under the

insurance plan and have contracted with the insurance
carriers to provide a reduced rate for services.

• Out of Network – Providers that you can access however

they have not contracted with the insurance carrier to
provide a reduced rate for services. You may have no
coverage if you access these providers and may be
responsible for the entire bill.

• Balance Billing – Excess costs you may be responsible for

if you access a provider that is out of network.