Copays, Deductibles & Coinsurance

When you use your health insurance plan, there are costs you pay out of pocket toward your care. Your out-of-pocket costs are sometimes referred to as your cost share. Copays, deductibles and coinsurance are common examples of cost share.

What are copays?

A copay, or copayment, is a set amount that you pay at the time and place of service. Not all plans and services require copays.

The amount of your copay may vary based on factors such as where you receive care. For example, copays are usually higher when you go to the hospital than when you go to your doctor’s office.

What is a deductible?

Your health plan may include an amount you need to pay toward covered services before the plan begins to pay. This is called the deductible.

If you have a family plan, you may have individual deductibles for each member, as well as a family deductible.

Until you’ve paid your deductible amount, you’re responsible for the full price of your medical bills. We’ll still process your claims and will adjust the amounts to reflect the rates we’ve negotiated with your care provider.

Once we process your claim, you’ll get an Explanation of Benefits (EOB) from us. Your EOB will show how much you can expect your provider’s office to bill you. You pay the provider, and we’ll credit the amount toward your deductible. 

What is coinsurance?

Once your health plan begins to pay for covered services, most plans pay a percentage of the cost. For instance, your plan may pay 80 percent. You would be responsible for the other 20 percent. This is your coinsurance.

Coinsurance will apply until you’ve reached your out-of-pocket maximum for the benefit year.

Review your benefits on My Health Toolkit® to learn more

If you want to know what your specific plan requires for copays, deductibles and coinsurance, log into My Health Toolkit. You can easily view your benefits information, including what you might owe when you receive care. Log into the secure site or use the mobile app.

Some plans may offer the option of having a financial account to use toward your out-of-pocket costs. You can manage these health spending accounts through My Health Toolkit, too.

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