COST OF COVERAGE
How You Pay for Health Care Costs
PREMIUM: A premium is the total cost for your medical insurance. You and Behavior Frontiers share this cost. You pay your portion through pre-tax payroll deductions.
Your Total Cost of Care
Remember, your total health care cost for the year is the combination of your out-of-pocket expenses when you access medical care and the premium contributions you make for coverage.
COPAY: A copay is a set payment you make for a specific service.
Premiums + Out-of-Pocket Costs
COINSURANCE: When you are paying coinsurance, you are sharing a percentage of the cost of services with the medical plan. For example, in the Classic PPO plan, after you satisfy your deductible, you will pay 20% coinsurance for most medical care that you receive from preferred providers. DEDUCTIBLE: A deductible is the amount you must pay before the medical plan begins sharing the cost of services. You pay this full amount, if required by your plan, before the plan pays benefits. For example, if you are enrolled in the Solution PPO plan, you must pay as much as $1,500 per person for covered care over the course of the calendar year before the plan pays any benefits. OUT-OF-POCKET MAXIMUM: The annual out-of-pocket maximum protects you from major medical expenses. This is the most you would pay, including your deductible, for eligible expenses during a year. Once you reach the out-of-pocket maximum, the plan pays 100% of the allowable charges for covered services. For example, if you are enrolled in the Classic PPO plan, your calendar year out-of-pocket maximum for in-network care is $4,000 per
= Total Cost of Health Care
Depending on your personal situation, the plan with the lowest deductible may not be the best plan for you. Be sure to take a good look at the total cost of your expected care before making your plan decisions for the year.
person to a maximum of $8,000 per family.
11 | Behavior Frontiers Benefits Guide
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