COMMON INSURANCE TERMS

Deductible
This is the portion any health insurance charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). Deductibles may vary from $0 to $10,000.

Coinsurance
Once the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay, In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% up to $5000. Then the insured's liability would stop and the insurance company would pay the remainder of eligible charges. Not all plans have coinsurance. Often, you won't find coinsurance in an HMO plan. Once the deductible and coinsurance have been met, the insurance company has the liability for any other covered health charges during the plan year.

Network
A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.