HEALTH INSURANCE 101
Before you enroll, here are some common terms you need to know and understand:
1. CO-INSURANCE
The percentage of a covered healthcare service cost you pay after you've paid your deductible.
2.
CO-PAYMENT A fixed dollar amount you pay for healthcare services, such as doctor’s visits, urgent care or emergency room services. Co-payments track towards your Out-of-Pocket Maximum, but do not apply towards the Deductible.
WHO PAYS FOR YOUR HEALTHCARE
Your Deductible, Co-Pays, and Coinsurance track toward your Out-of-Pocket Maximum Once you have reached your OOP Max, your Plan will pay for any charged services covered by Your Plan
All Other Covered Expenses
3. DEDUCTIBLE
The amount you pay for certain covered healthcare services before your insurance plan starts to pay on your behalf.
Out-of-Pocket Maximum
4.
OUT-OF-POCKET MAXIMUM The most you will pay for healthcare services in one year. After you spend this amount on deductibles, co-payments, and coinsurance, your health plan pays 100% of the costs for covered benefits (with some exceptions). PREMIUM This is the cost you will pay to participate in the employer health plan. Your Premium is separate from your Deductible and Out-of-Pocket Maximum.
You and Your Plan each pay a % after your Deductible has been met
Coinsurance
Deductible and Co-Pays
You Pay
5.
Your Plan Pays
Preventive Care
6.
PREVENTIVE CARE Routine healthcare services like check-ups, immunizations, and screenings for adults, women, and children.
Premium
You Pay
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