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UNDERSTANDING COMMON INSURANCE TERMS

Deductible

The amount you pay for most covered services before your health plan starts to pay. Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.

For example, if your plan has an annual deductible of $1,000, you may be responsible for all healthcare costs until your deductible is reached for the year.

Copay

A fixed amount you pay for a covered service,  usually at the time of service. Amount can vary based on the type of service. For example, your plan may have a $30 copay for specialist visits, due at each visit.

Coinsurance

Percentage of costs you pay after you’ve met your deductible. For example, after you’ve met your plans deductible, if you have a 10% coinsurance, you would be responsible for 10% of the total charges, while your health plan would cover the other 90%. Example: $100 charged for a covered service. You would be responsible for $10 and your health insurance plan would cover the other $90.

Out-of-Network

If you are receiving services at a provider who is out-of-network with your insurance plan, your coverage may differ. Please contact your insurance carrier for more information on your out-of-network benefits.

Additional Questions

The above content was paraphrased from the Blue Cross Blue Shield website. 

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