Definitions and Your Benefits

PLEASE NOTE: The information below describes in-network benefits only.

What is my Deductible?

The amount you pay for all covered health care services before your health insurance begins to pay.

  • Your plan has a $300 single in-network deductible and $600 family in-network deductible
  • REMINDER: If a service has a copay (ie. $20 copay for primary care office visits) these services are NOT subject to the deductible nor do they apply to the deductible.

What is my Coinsurance?

Once you've met your deductible, this is your share of cost of health care services up to the coinsurance limit.

  • The coinsurance limit on your plan is 10%
  • REMINDER: If a service has a copay (ie. $20 copay for primary care office visits) these services are NOT subject to the coinsurance nor do they apply to the coinsurance limit.

What is my Coinsurance Limit?

The most you have to pay for covered medical services during the calendar year: Once met, the plan pays 100% for all medical services EXCEPT services with a copay.

  • Your plan has a $500 single in-network coinsurance limit and $1,000 family in-network coinsurance limit.

What is my Out-of-Pocket Limit?

Healthcare Reform sets a statutory limit each year for all services a member pays during a calendar year. This limit includes deductible, coinsurance AND medical/prescription drug copayments. Once met, a health plan must pay 100% of the costs of all covered medical/Rx benefits.

  • The statutory limit is $7,150 for those with single coverage and $14,300 for those with family coverage.
  • Once you've met your deductible and coinsurance limit, which is $800 single and $1,600 family, you will solely be responsible for the payment of copayments.
  • REMINDER: Prior to HealthCare Reform, copayments were unlimited.

Please Note: This is informational in nature. It is not medical advice.

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