Page 36 - Guide
P. 36
Glossary of Terms
Coinsurance
Coinsurance is the percentage of the bill that is your responsibility once all of the
deductible amount has been satisied. Coinsurance is applied to same services as the
deductible.
Copay
A copay is a speciied amount you will pay for out-of-pocket expenses for healthcare
services such as doctor visits and prescription drugs at the time the service is
rendered, with the plan paying the remaining costs.
Deductible
A deductible is the amount of money you must pay before the plan begins paying
beneits.
Explanation of Benefits (EOB)
A document sent by an insurer to a patient explaining what was covered for
a medical service, and how they arrived at the payment amount and patient
responsibility amount.
In-Network Providers/Services
In-network providers are doctors who are contracted with the insurance company.
In-network providers do not balance bill for covered services. They must accept
the amount paid by the plan (plus any member copayment and/or coinsurance)
as stipulated in their contracts. Non-network providers, however, are not under
contracts so they can balance bill.
Out-of-Pocket Maximum
The out-of-pocket maximum is designed to protect you in the event of a
catastrophic illness or injury. After you have paid the speciied out-of-pocket amount
during a policy year, the plan pays the remaining covered services at 100%.
Premium
The amount a member or group pays on a periodic basis for coverage as deined
in the member’s health insurance certiicate or contract.
Hussmann
Corporation
36
Coinsurance
Coinsurance is the percentage of the bill that is your responsibility once all of the
deductible amount has been satisied. Coinsurance is applied to same services as the
deductible.
Copay
A copay is a speciied amount you will pay for out-of-pocket expenses for healthcare
services such as doctor visits and prescription drugs at the time the service is
rendered, with the plan paying the remaining costs.
Deductible
A deductible is the amount of money you must pay before the plan begins paying
beneits.
Explanation of Benefits (EOB)
A document sent by an insurer to a patient explaining what was covered for
a medical service, and how they arrived at the payment amount and patient
responsibility amount.
In-Network Providers/Services
In-network providers are doctors who are contracted with the insurance company.
In-network providers do not balance bill for covered services. They must accept
the amount paid by the plan (plus any member copayment and/or coinsurance)
as stipulated in their contracts. Non-network providers, however, are not under
contracts so they can balance bill.
Out-of-Pocket Maximum
The out-of-pocket maximum is designed to protect you in the event of a
catastrophic illness or injury. After you have paid the speciied out-of-pocket amount
during a policy year, the plan pays the remaining covered services at 100%.
Premium
The amount a member or group pays on a periodic basis for coverage as deined
in the member’s health insurance certiicate or contract.
Hussmann
Corporation
36
