Coinsurance
After each individual
satisfies the $200 annual deductible, each individual must share any remaining
expenses with the plan. This is called “coinsurance.” There are
three coinsurance payment levels depending on the type of service or supply
received and the type of health care provider used:
- 90%
– 10% Most services and supplies are paid at 90 percent by the plan
and at 10 percent by the individual. When the individual’s coinsurance
reaches $2,300 in a calendar year (the annual coinsurance maximum), benefits
that would otherwise be paid at 90 percent are paid at 100 percent for the
remainder of that calendar year. A family’s annual coinsurance maximum is
$4,600.
- 80%
– 20% Several services are paid at 80 percent by the plan and at 20
percent by the individual. These services always require 20 percent coinsurance
by the individual and these coinsurance payments do not apply toward the $2,300
annual coinsurance maximum.
- 50%
– 50% Several services are paid at 50 percent by the plan and at 50
percent by the individual. These services always require 50 percent coinsurance
by the individual and these coinsurance payments do not apply toward the $2,300
annual coinsurance maximum (except orthognathic surgery).
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