Health & Security Retiree Health Plan > SPD > Coinsurance

Summary Plan Description

Coinsurance

After you satisfy your $200 annual deductible, you must share many remaining expenses with the plan. This is called "coinsurance." Each individual covered under the plan has his or her own 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 you. When your 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 you. These benefits always require 20 percent coinsurance and these coinsurance payments do not apply toward the $2,300 annual coinsurance maximum.

Key Point

When you move from the Employee Health Plan to the Retiree Health Plan during a calendar year, any coinsurance expenses that were satisfied under the Employee Health Plan will also apply toward the coinsurance expenses under the Retiree Health Plan.

Helpful Hint

If you are eligible for Medicare, you are required to satisfy the deductibles and coinsurance under Medicare as well as the deductible, copayments and coinsurance under this plan. However, charges that are applied to Medicare's deductibles can also apply to this plan's deductible. Therefore, you should send all provider billings to the Trust Office even if the billings were applied to Medicare's deductibles.