Frequently Asked Questions

A deductible is the amount of money you or your dependents must pay toward a health claim before your health plan makes any payments for covered health care services.

Coinsurance is the percentage of costs you must pay and that which the health plan must pay.

The maximum amount (deductible, copay, and coinsurance) that you will pay for covered expenses under a plan. Once the out-of-pocket maximum is reached, the plan will cover eligible expenses at 100%.

Typically refers to physicians, hospitals, or other health care providers who contract with the insurance plan (usually an HMO or PPO) to provide services to its members. Coverage for services received from in-network providers will typically be greater than for services received from out-of-network providers, depending on the plan.

A fixed amount ($20, for example) you pay for a covered health care service at the time of service.