Billing & Insurance Questions
Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are provided.
For example, if a member’s policy contains a $250 deductible, the member must accumulate $250 in covered expenses before reimbursement begins. Most traditional plans feature a $200 to $500 deductible, and then pay 80% to 100% for covered services. With most plans, the higher the deductible, the lower the premium.
A co-payment is usually a fixed fee ($5, $10, $15, $20) the member pays to providers at the time covered services are performed. The level of co-payment is determined by the benefit option. Co-payments are applied to office visits, emergency room visits, hospital admissions and other medical care under some products.
After deductibles are met, the plan begins paying a percentage (usually between 80% to 100%) of covered services. The remaining amount, called coinsurance, is borne by the member. Coinsurance is a form of cost sharing.