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About Your Coverage: Health Insurance 101 Health insurance can be complicated, and that’s why we try to make it easy to understand your coverage and financial responsibilities. Take a moment to learn about important terms and where to find your specific coverage details.
Sharing the Cost of Care
Your policy may use a system of cost sharing that can include a copay, coinsurance, deductible or any combination of the three.*
Deductible Each time you receive medical services, you’ll pay the bill towards these services up to a certain amount. This amount is your deductible, which is what you must pay for covered health care services each year before we begin to pay. Coinsurance† Once you’ve paid the deductible amount, your insurance will then start splitting the cost of additional medical services with you. This is known as coinsurance, where you only pay a percentage or part of the total cost of services and we’ll pay the rest.
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Deductible and Coinsurance Limit – There is a dollar limit to the amount you’ll pay towards your deductible and coinsurance. Copays
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A copay is a fixed dollar amount, which you pay at the time you receive medical services (for things like an office visit) and prescriptions. All your copays add up toward your Maximum Out-of-Pocket total.
* Not all of the cost-sharing terms listed here apply to all members. Refer to your Member Policy document to understand which apply to you. Smart Plan medical copayment applies towards the out-of-pocket maximum, which is the amount you are required to pay toward the covered cost of your healthcare. The out-of-pocket maximum amount is calculated on a calendar year basis. For members with PPO and POS Smart Plans, coinsurance and copays apply. † Coinsurance is your share of the costs of a covered health care service. It’s calculated as a percent of the allowed amount for the service.
Maximum Out-of-Pocket – There’s a dollar limit to all your cost sharing. You reach this amount by means of your deductible, plus your coinsurance, plus your copays. Once this limit is reached, you’ll pay nothing on subsequent covered medical charges for the remainder of your policy year.
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| 2023 Group Insurance Plans
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