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Association /Fee
COINSURANCE
MAX OUT OF POCKET
A deductible is an amount you pay for most eligible medical services before your health plan begins to share in the cost of covered services.
If your plan includes copays, you pay the copay flat fee at the time of service. There may be some expenses covered by your plan. Make sure to look at the brochure before choosing a plan.
If your plan does not have copays then you will most likely get a PPO network discount if you use a doctor that you verify is “IN NETWORK.” Each carrier has a doctor look-up link.
How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance unless you chose a plan with no coinsurance.
Low deductibles are best when an illness or injury requires extensive medical care. High-deductible plans offer more manageable premiums. An HMA (Health Match Accounts)
Coinsurance is the amount you pay for covered
health care after you meet your deductible. This
amount is a percentage of the total cost of care
For example: you pay 20%—and your plan
covers the 80%
The higher the percentage the insurance company
pays, the higher your premium will be. A 50/50 plan
will cost less than a 70/30 or 80/20. Some plans have
NO COINSURANCE (100%) which will be more expensive.
TIP: An HMA (Health Match Account) is always great to help with out of pocket expenses Like coinsurance.
The most you have to pay for covered services in
a plan year. After you spend this amount on
deductibles, copayments, and coinsurance for in-
network care and services, your health plan pays
100% of the costs of covered benefits.
This amount is usually adjustable. The higher your
max out of pocket the lower your premium will be.
DEDUCTIBLE
COINSURANCE
MAX OUT OF POCKET
A deductible is an amount you pay for most eligible medical services before your health plan begins to share in the cost of covered services.
If your plan includes copays, you pay the copay flat fee at the time of service. There may be some expenses covered by your plan. Make sure to look at the brochure before choosing a plan.
If your plan does not have copays then you will most likely get a PPO network discount if you use a doctor that you verify is “IN NETWORK.” Each carrier has a doctor look-up link.
How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance unless you chose a plan with no coinsurance.
Low deductibles are best when an illness or injury requires extensive medical care. High-deductible plans offer more manageable premiums.
Coinsurance is the amount you pay for covered
health care after you meet your deductible. This
amount is a percentage of the total cost of care
For example: you pay 20%—and your plan
covers the 80%
The higher the percentage the insurance company
pays, the higher your premium will be. A 50/50 plan
will cost less than a 70/30 or 80/20. Some plans have
NO COINSURANCE (100%) which will be more expensive.
The most you have to pay for covered services in
a plan year. After you spend this amount on
deductibles, copayments, and coinsurance for in-
network care and services, your health plan pays
100% of the costs of covered benefits.
This amount is usually adjustable. The higher your
max out of pocket the lower your premium will be.
HEALTH MATCH ACCOUNT
(HMA)
SHORT TERM MEDICAL
INDEMNITY
PLAN
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TRIOMed
(NatGen Supplement)
UNITED HPG (United Supplement)
PPO
NETWORK
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PPO stands for Preferred Provider Organization. In a PPO, members enjoy the freedom to see any physician or other health care professional from the network of participating providers, including specialists, without a referral
HMO
HMO stands for health maintenance organization. HMOs have their own small local network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. Many find this to be inconvenience, especially when traveling outside their local area.
