Page 10 - 2020 McLennan County Benefits Enrollment Guide

Copayments and Coinsurance
A copayment (copay) is the fixed dollar amount you pay for certain in-network services. In some cases, you may be
responsible for coinsurance after the copay is made.

Coinsurance is the percentage of covered expenses shared by the employee and the plan. In some cases, coinsurance is
paid after the insured meets a deductible. For example, if the plan pays 80% of an in-network covered charge, you pay
20%.

Out of Pocket Maximum

The plans feature an out-of-pocket maximum, which limits the amount of coinsurance you will pay for eligible health
care expenses. Once you reach that maximum, the plan begins to pay 100% of eligible expenses. Due to health care
reform, copays and deductibles, including those incurred for prescriptions, will apply to your out-of-pocket maximum
accumulation.

Preventive and Non-preventive Services

These are services generally linked to routine wellness exams. Non-preventive services are those that are considered
treatment or diagnosis for an illness, injury or other medical condition. There may be limits on how often you can
receive preventive care treatments and services. Please also note that preventive services are not applied to your
deductible. You should ask your health care provider whether your visit is considered routine/preventive or non-
preventive care. Examples of preventive are include:

• Annual routine physicals (see plan for guidelines and details)
• Bone-density tests
• Immunizations
• Pelvic exams
• Mammograms
• Pap smears
• Cholesterol screenings
• PSA exams
• Prenatal exams and gestational diabetes tests
• Breastfeeding supplies and counseling
• Screening and counseling for HIV, HPV and domestic violence
• Contraceptive drugs, devices and sterilization (see plan for details)

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