2. Deductible Your deductible is what you pay up-front for care and is a set amount for the year. For most services, you will have to pay the full cost until you hit your deductible amount. After that, your health plan kicks in and shares costs for the rest of the year. 3. Copay A copay is a fixed amount that you pay when you receive care. How this works with your deductible: Typically, you don't need to meet your deductible for the copay amount to apply, and the money you spend on copays doesn't count toward your deductible. For example: If your plan has a $20 copay for every in-network specialist visit, you will owe $20 when you go in for your visit. 4. Coinsurance Coinsurance is a varying amount that you pay when you receive care and is calculated as a percentage of the allowed amount for a service. How this works with your deductible: Typically, coinsurance doesn't kick in until you've met your deductible. For example: You’ve met your deductible of $1,000. If your plan has a 10% coinsurance for every in- network specialist visit, and your recent visit is $100, you will owe $10. 1. Premium Your premium, also known as your employee contribution, is the amount you pay for health care coverage, and is deducted from your paycheck.
5. Out-Of-Pocket Maximum The out-of- pocket maximum is the most you’ll pay for care during your plan year before your health insurance begins to pay 100 percent of any allowed amounts. It’s important to note that this amount does NOT include your premium, balance-billed charges, or healthcare services your plan doesn’t cover
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2023 Benefits Guide
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