Understanding Insurance Terms
DEDUCTIBLE ($100 Single/$200 Family)
The amount you are required pay for health care services before the health plan begins to pay for certain medical services. Deductibles are based upon a calendar year, which means each January 1 your deductible amount starts over.
No one person covered under a family contract will have a greater Deductible than an individual with single coverage. All family members combined would not pay more than the stated family deductible, even if no family member meets the single deductible. This means the family deductible could be met by any combination of family.
COINSURANCE ($400 Single/$800 Family)
Coinsurance is your share of the costs of a covered health care service. It is a percentage of the allowed amount, in CH-UH it is 10% as of January 1, 2021. This means the plan will pay 90% of the allowed amount, and the member pays 10%. Coinsurance applies after the deductible is met.
COINSURANCE MAXIMUM ($400 Single/$800 Family)
The maximum dollar amount you are required to pay before the plan begins paying certain covered expenses at 100%. The coinsurance maximum does not include your deductible. Coinsurance typically does not apply to services that have a flat dollar copay.
No one person covered under a family contract will have a greater Coinsurance Maximum than an individual with single coverage. The Coinsurance Maximum for all family members accumulate toward the family. All family members combined would not pay more than the stated family coinsurance maximum, even if no family member meets the single coinsurance maximum. This means the family coinsurance maximum could be met by any combination of family members.
MAXIMUM OUT-OF-POCKET ($6,850 Single/$13,700 Family)
The maximum dollar amount you are required to pay out-of-pocket during a calendar year. The maximum out-of-pocket includes deductible + coinsurance + medical and prescription drug copays.
Until this maximum is met, the plan and member share the cost of covered expenses. When the member has reached the Maximum Out-of-Pocket, the plan will pay 100% - copays will no longer be taken.
No one person covered under a family contract will have a greater Maximum Out-of-Pocket than an individual with single coverage. The Maximum Out-of-Pocket for all family members accumulate toward the family. All family members combined would not pay more than the stated family Maximum Out-of-Pocket, even if no family member meets the single Maximum Out-of-Pocket. This means the family Maximum Out-of-Pocket could be met by any combination of family members. After the maximum is met, the plan begins paying all covered services at 100%.
COPAYMENT (COPAY)
A flat dollar amount you are required to pay at the time services are rendered. For services that require a flat dollar copay, deductible and coinsurance do not apply. Office visits for injury or illness are $15. Prescriptions are $5 generic/$15 Formulary/$50 Non-Formulary. Look for further specifics on Formulary as we get it.
v12/3/2020