Medical Terms to Know
Medical Terms to Know
Employee Contribution or Premium
The amount you pay out of your paycheck when you enroll.
Copay
A flat dollar amount you pay for a covered health service. Deductibles and coinsurance do not apply when services require a copay.
Deductible
The amount you may need to pay up front each calendar year before the plan begins paying covered expenses. Not all services are subject to a deductible.
Coinsurance
The portion of the cost you pay after you meet your annual deductible. Coinsurance is a percentage of the allowable amount. The plan pays a percentage of the allowable amount and you pay a percentage.
Out-of-Pocket Maximum
The most you’ll pay in a calendar year for covered medical and prescription drug expenses. Copays, deductibles and coinsurance payments count toward the out-of-pocket maximum. Any covered expenses above the out-of-pocket maximum will generally be covered by the plan at 100% for the rest of the calendar year.