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Key Terms

  • Deductible - the amount you pay each year before your plan starts to pay.

  • Copay - a flat fee you pay for covered services like doctor visits.

  • Coinsurance - your share of health plan costs (a percentage of total costs) after meeting your deductible.

  • Out-of-Pocket Maximum - the most you have to pay out-of-pocket each year for health care services.  once this amount is reached, insurance will pick up 100% of any subsequent qualifying expenses.

  • Premium - The amount you pay to belong to a health plan.

  • In Network - Providers who have agreed to render services at a negotiated rate

  • Out of Network - Providers who have not agreed to provide services at the negotiated rate.  Members can still see these providers, but may experience higher fees, balance billing for the difference between the charged fee and the negotiated rate as well as different deductible out-of-pocket maximum.