Deductibles & Out-of-Pocket Expenses
The types of expenses are defined as follows:
- Co-payment: a dollar amount that you are required to pay at the time services are rendered.
- Co-insurance: 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.
