A co-payment (co-pays) is a designated dollar amount paid by the insured to receive specified services. This is payable at the time of service. Some plans require co-pays for doctor visits, prescription drugs and emergency room visits. Co-payments are separate from the deductible amount and normally do not apply toward the annual deductible. Additionally, the deductible does not usually need to be satisfied before a co-payment applies. Please refer to the Summary of Benefits provided by your health plan for specifics of your health plan.
Coinsurance is a cost-sharing requirement under certain health insurance policies. It requires the insured (patient) and the insurer (the employer or health plan) to pay a portion or percentage of the costs for covered services. For example, a plan with an '80/20' coinsurance design would require the employer to pay 80% of the allowable and the patient to pay 20%. Please refer to your plan document for your actual benefit.
The deductible is the amount of money an insured needs to satisfy after making a claim before their insurance company provides benefit coverage. With health insurance, deductibles usually range from $500 to $5,000. So if the insured has a $1,000 deductible, for example, and has a $10,000 claim, he/she will be responsible to pay $1,000 before the insurer starts paying coverage.
The out-of-pocket maximum is a predetermined limited amount of money that an individual must pay out of their own pocket, before an insurance company will pay 100 percent for an individual's health care expenses.