UNDERSTANDING YOUR BENEFITS

Deductible

Some plans have an annual deductible. This is the amount you pay out of pocket before your health insurance begins to pay. Deductibles usually start over at the beginning of each year.

Example: If you have a deductible of $1,500, you’ll pay 100% of your medical and pharmacy bills until you get to $1,500. After that, you may share the cost with your plan by paying coinsurance and copays.

Coinsurance

Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount charged for the visit. You may start paying coinsurance after you’ve paid your plan’s deductible.

Example: Once you reach your $1,500 deductible, you’ll split the cost of medical care with your insurance company. They’ll pay 70% of the bill. You pay the rest — 30%. If the visit costs $100, you’ll pay $30.

Copay

A copay is a fixed amount you pay for a health care service. You pay your copay when you get the service. The amount can vary by the type of service. For instance, it might be $30 copay to see a primary care doctor, and a $50 copay to see a specialist.

Out-of-Network or In-Network

In-Network: refers to providers who have a contract with your insurance company. They usually charge members a lower rate.

Out-of-Network (OON): Providers who don’t have a contract with your insurance company. You will usually pay more to see an out-of-network provider. And in some cases, your insurance company won’t cover care by an OON provider.

Insurance can be confusing. If you have any questions, feel free to call. We’re here to help.