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.
Note: Retirees who have Medicare Part B as their primary health plan (age 65 and older) are not subject to the co-payment when the RHP pays as secondary. However, for services not covered by Medicare and the service is a covered benefit by the RHP, the RHP then pays as primary. In this instance, you could be responsible for the applicable co-payment.
