It includes things like your deductible, copays, and coinsurance payments. Out-of-Pocket Maximum: The most you'll have to pay for healthcare in a given year. It will tell you exactly what your deductible, copay, coinsurance, etc. Plan Document: The thick stack of papers you'll get when you sign on for a new plan that includes every little detail about your plan. You'll have to pay for these on your own, and they won't count toward your deductible or out-of-pocket max (common examples: lasik eye surgery, nose job, accupuncture.).įamily deductible: the collective amount spent on covered services for all family members before the plan starts paying - it's not per person. Not Covered: No your health plan will not pay for this. (common examples: doctor's office, pediatrician, mammogram). Premium: The amount taken out of your paycheck each month.Ĭovered: Yes your health plan will pay for this. So if the charge is $100 and your coinsurance is 50%, you pay $50. Could be $0, could be $50 depending on what type of plan you have and what type of doctor it is.Ĭoinsurance: For some services or prescriptions, you're required to pay a percentage of the total charges. (So: if your deductible is $1,000, you have to buy $1,000 worth of covered care before the plan helps pay for anything).Ĭopay: How much you pay at the front desk. Here are some of the words you need to know (in plain English):ĭeductible: The amount you personally have to pay before your health insurance starts sharing costs.
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