Common Insurance Terms (if you don't see it here just ask and then we'll add it)

Coinsurance
Copay
Deductible
EOB
Network Negotiated Rate

Coinsurance -- After you meet the deductible is when you start to share the cost with the insurance company. This is called “coinsurance.” The way our quote engine list the coinsurance is the amount you would pay. So, if it says 20%, you’d pay that amount of future bills. If it says 0%, then you’d pay no more of the covered expenses after the deductible is met
back to top

Copay -- Some plans have flat amounts that you pay for services. These flat amounts are called copays. Usually they are completely unrelated to and don't count towards your deductible. So, if a plan had a $25 copay for office visits, regardless of what your deductible is you would pay $25 when you visit the doctor. You need to check the plan to understand whether the number of visits is limited during the year AND what services are covered under the copay. Plans with copays are not necessarily better, but some consumers like to know what they're going to pay when they have a doctor's visit. Don't pay much more for a plan with a copay over one without. It generally doesn't make sense to pay the extra premium.
back to top

Deductible -- This is the amount of a bill (or cummulative bills) you would be responsible for before the insurance company starts paying (or sharing) the cost of medical bills. The bills you incur usually apply towards your deductible; therefore, if you have no bills then you won't pay a deductible. It's important to understand what types of bills are subject to a deductible as some items are covered by a copay .

Also is your deductible "per incident" or "annual?" Per incident means EVERY time you go to the hospital, for example, so you start at zero for each incident. Whereas an "annual" deductible allows you to accumulate your bills to meet the deductible and get the plan to start paying. Annual is better. Higher deductibles usually equate to a lower cost plan, BUT a lower deductible isn't necessarily better. In other words, if a lower deductible plan costs more than the difference between that and a higher deductible, you should consider the hgher deductible. (if a $250 deductible costs more than $500 a year than the $750 deductible (and there are no other differences) choose the $750.
back to top

EOB -- Explanation Of Benefits. This is the form you get in the mail after you incur a medical expense. The provider bills the insurance company or network and the rate is usually adjusted to reflect the network negotiated rate or the URC (usual, reasonable, customary) charge. After the charge is adjusted the "allowed" amount travels through the insurance. Never pay a doctor or hospital bill until you've matched it up with the explanation of benefits, that's the only way you'd know if you were actually responsible for paying the bill and whether the provider billed the insurance company .
back to top

Network Negotiated Rate -- This is the fee that the provider (doctor, hospital, lab, etc...) has agreed to accept for a particular service. This amount is usually less then what they would normally charge. If you have a discount plan this amount would be your responsibility. If you have insurance this is the amount that would be applied towards your deductible and coinsurance. If you have any "EOBs" lying around you'll see a "charged rate" and an "amount allowed." The amount allowed is the negotiated rate. If you are "out-of-network" then the difference between these amounts is also your responsibliity outside of the plan.
back to top