Premium: The amount you and/or your employer pays each month to receive insurance coverage.
Deductible: The dollar amount you must pay out of pocket before your insurance company will start to pay. Deductibles are based on your benefit period, which is typically 1 year.
Example: If your plan has a $2,000 annual deductible, you will be expected to pay the first $2,000 toward your healthcare services. After you reach $2,000, your health insurer will begin to pay for their share of the cost.
Co-pay or co-insurance: Both are when you and your insurance company share responsibility for paying for services. Both are predetermined by your insurance company.
Co-pay: Flat fee that you pay your healthcare provider at the time you receive services. You may have to pay a copay for each visit, depending on your plan. Not all plans have a co-pay.
Co-insurance: A certain percent that you must pay after you have paid your deductible. You may still have to pay a copay.
Non-covered charges: Charges for services and supplies that are not covered under the health plan. Examples of non-covered charges may include things like audio/phone therapy or marriage counseling.
In-network provider: A healthcare provider who is part of a plan’s network. You will typically pay less for services within an in-network provider.
Out-of-network provider: A healthcare provider who is not part of a plan’s network. Costs associated with out-of-network providers may be higher or not covered by your plan. Consult your plan for more information.
