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 two coinsurance payment levels depending on the type of service or
supply received and the type of health care provider used:
- 90%
- 10% Most benefits 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.
When
the retiree, spouse and dependent children have incurred a combined coinsurance
expense of $4,600 in a calendar year, no further coinsurance is required for any
family member during that calendar year, except as described
below.
- 80%
- 20% Benefits for chemical
dependency, chiropractic care, mental health care, and neuropsychological
assessments or tests are paid at 80 percent by the plan and at 20 percent by the
individual. These benefits always require 20 percent coinsurance by the
individual and these coinsurance payments do not apply toward the $2,300 annual
coinsurance maximum described above.
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