4 Fundamentals

We don’t have to be health insurance experts, but we should all know these fundamentals.

It’s important to know your benefits or where to look them up. But you should know at least these four aspects of your plan:

4 fundamentals note card

  1. The deductible is the amount a health plan member must pay for certain covered services before the plan will begin to pay benefits.
  2. The co-payment is the fixed amount you pay toward charges for things such as office visits and prescriptions.
  3. The co-insurance is a percentage you pay toward medical services after you have met your deductible. By agreeing to pay a co-insurance percentage of medical charges, you pay less in premiums. If your co-insurance level is 80%, the insurance company pays 80% of the medical charges and you pay 20%.
  4. The annual out-of-pocket maximum is the maximum cost sharing amount you are required to pay for covered services in a plan year. Keep in mind, co-payments may not apply toward your annual out-of-pocket maximum.

Also, if you have a health savings or reimbursement account, you need to be familiar with how they work and your account balance.

The 4 Things to Know

Understanding the fundamentals