Health Insurance Terms

All costs to the consumer beyond premiums, includes deductible, co-pays, and coinsurance. Also called “out of pocket” costs.

The amount you pay to share the cost of covered services after your deductible has been paid. Coinsurance is usually a flat rate or percentage. For example, if the insurance company pays 80%, you pay 20%.

One of the ways you share in your medical costs. You pay a flat fee for certain medical expenses (e.g. $10 for every visit to the doctor), after you have met your deductible, if applicable.

The amount of money you must pay each year towards eligible medical expenses before your insurance carrier begins to pay.

A type of deductible where both prescription drug and medical expenses contribute towards the deductible. If the deductible is not integrated, only medical expenses accumulate to the medical deductible and prescription drug claims accumulate to the prescription drug deductible.

A type of out of pocket maximum where both prescription drug and medical expenses contribute towards the out of pocket maximum.

This is the most money you will pay during a year for care. it includes deductible, copayments, and coinsurance, but is in addition to your regular premiums. Beyond this amount, the insurance company will pay all expenses for the remainder of the year.