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Health Insurance Definitions

What is coinsurance?

The way an insurance plan shares costs with you. For example, when you receive car, the medical plan pays 80% coinsurance for eligible in-network services, and you pay 20% coinsurance.

What is a copayment or copay?

A flat dollar amount you pay every time for certain services such as physician office visits. Copayments do not count toward the deductible or the out-of-pocket maximum.

What is a deductible?

The amount you must pay for eligible services before the plan begins paying anything for the policy year. The deductible does not count toward the out-of-pocket maximum.

What does in-network mean?

Doctors and other healthcare providers who agree to charge plan members a lower, negotiated cost for healthcare services.

What is an out-of-pocket cost?

What you pay when you receive care, including copayments, amounts you pay toward the deductible and your share of coinsurance.

What is an out-of-pocket maximum?

The amount you must pay through coinsurance before the plan pays 100% of the cost for your eligible services for the rest of the policy year. In other words, once you reach the out-of-pocket maximum, the plan pays 100% of your eligible costs (excluding copayments).

What is a premium cost?

The amount you pay for coverage. The premium cost is charged to your bursar's account.