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How you will pay for health
care services
When you receive medical care or fill a prescription, you may be responsible for making a payment. These payments are often called cost-sharing, or out-of-pocket costs, and come in the following types:
Deductible
A deductible is the amount you pay each year before your health plan starts paying for covered services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for the health care services you receive in any given year. Once you’ve paid this amount, your insurance will begin to pay a portion or all of your health care costs, depending on the plan.
Coinsurance
Coinsurance is the percentage you pay for some covered services. Once you have met your deductible amount for the year, you will only need to cover the cost of your coinsurance. If your coinsurance is 20 percent, your health insurance company will pay 80 percent of the cost of covered services. You will pay the remaining 20 percent — your costs are usually based on a discounted amount negotiated by Independence.
Copay
A copay is a flat fee you will pay. With your health plan, you will pay a copay when you fill a prescription drug. For example, you might pay a flat fee of $20 for a prescription drug.
Out-of-pocket maximum
An out-of-pocket maximum is the most you will have to pay for your health care expenses during a plan year for covered services received from providers that participate in the plan’s network. No matter what, you will not pay more than this maximum amount in a given year. Any care you receive for covered services after you meet your out-of-pocket maximum will be covered 100 percent by Independence.
Get preventive care for $0
Receive checkups, screenings, and immunizations at no cost to you and your family. Visit ibx.com/preventive to see recommended preventive care options by age and gender.
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