Deductibles & Out-of-Pocket Expenses

Deductibles & Out-of-Pocket Expenses 

The types of expenses are defined as follows:

  • Copayment: a dollar amount that you are required to pay at the time services are rendered.
  • Coinsurance: the percentage the member is responsible for when coverage is less than 100%.
  • Deductible: an amount, usually stated in dollars, for which you are responsible each benefit period before the third party administrator will start to reimburse benefits.
  • Out-of-Pocket Maximum: the accrued value of copay and co-insurance payments that has to be satisfied in the plan year before the reimbursement for covered services will be paid in full.
The out-of-pocket expenses chart summarizes the different costs based on the service you receive. For scenarios of how deductibles apply, click here
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