Common Health Insurance Terms – Dean 101

Common Health Insurance Terms – Dean 101


Let’s say you’re feeling great
because you just got coverage with Dean Health Plan. When the time comes that you need to use medical services, you’ll eventually experience some cost-sharing
terms based on the plan you choose. Let’s start with copays. Copays are a fixed
dollar amount which you pay at the time you receive medical services. You’ll
probably pay a copay for things like a prescription, an office visit or seeing a
specialist. Next, let’s talk about your deductible. Your deductible is what you
must pay for covered medical services each year before your insurance begins
to pay. Most people pay their deductible at the beginning of the year as they
begin to receive medical services. So if your insurance plan has a $250 deductible and you end up needing physical therapy, you’ll have to pay $250 towards your medical bills before your insurance begins to pay. After you’ve paid your deductible amount,
you’ll pay coinsurance. Coinsurance just means that your insurance will start
splitting the cost of medical services with you. For example, later on in the year if you stayed in the hospital it could come at
a high cost. If the stay was $2,500 and your coinsurance is ten percent of the
bill, that means your insurance would be responsible for paying 90% of the bill,
which in this case amounts to $2,250. You’d be responsible for the remaining ten percent of the bill which works out
to $250. To keep health care affordable for your budget, most plans have a dollar limit to the amount you have to pay towards your
deductible and coinsurance. Not surprisingly, this is called your
deductible and coinsurance limit. Thinking back to the previous examples,
if your deductible and coinsurance limit was $500, that would mean
you’ve met your deductible and coinsurance limit for the year. That’s
because you would have already paid $250 towards your deductible and an additional $250 towards your coinsurance for when you stayed in the hospital. There’s also another kind of limit called your maximum out-of-pocket, which sets a cap to all your
cost-sharing. That means once this limit is reached, you’ll pay nothing on subsequent covered medical charges for the remainder of
your policy year. You reach the limit by means of your deductible, coinsurance and copays. It’s a smart idea to make sure you know the ins and the outs of your
health insurance. Just visit deancare.com to find your member certificate
document. The document provides specific details about your copays, deductible,
coinsurance and maximum out-of-pocket. We hope this was insightful. Thanks for
watching!

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