Frequently Asked Questions
- What is a Premium, Deductible, Co-pay, Out-of-Pocket Maximum and Co-insurance?
Here are some general definitions of the different terms. Please note that your plan may define these terms differently. Refer to your plan documents for accurate definitions.
- Premium - Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor.
- Copayment - A form of medical cost sharing in a health insurance plan that requires an
insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the cost. There may be separate copayments for different services. Copay doesn't usually count towards deductible.
- Deductible - A fixed dollar amount during the benefit period - usually a year - that an
insured person pays before the insurer starts to make payments for covered medical
services. Plans may have both per individual and family deductibles. Deductibles may differ if services are received from an approved provider or if
received from providers not on the approved list.
- Coinsurance - A form of medical cost sharing in a health insurance plan that requires an
insured person to pay a stated percentage of medical expenses after the deductible
amount, if any, was paid. Once any deductible amount and coinsurance are paid, the insurer is responsible
for the rest of the reimbursement for covered benefits up to allowed charges: the
individual could also be responsible for any charges in excess of what the insurer
determines to be "usual, customary and reasonable". Coinsurance rates may differ if services are received from an approved provider or if received by providers not
on the approved list. The rates may also differ for different types of services.
- Out-of-pocket Maximum - The maximum dollar amount a group member is
required to pay out of pocket during a year. Until this maximum is met, the plan and
group member shares in the cost of covered expenses. After the maximum is reached, the
insurance carrier pays all covered expenses, often up to a lifetime maximum.
How do I use this tool?
Fill out the fields that define your insurance plans. If you want to try things before filling out the fields, click on "Load Sample" link. Clear the sample data before continuing with your plan information. After you provide the plan information, the annual cost shows how much you will spend in a year if you do not use any medical service at all.
Can we have this tool customized for our company plans?
Once you have entered the plan information, use the +/- buttons in the Health-Meter to set your expected health care needs. As you adjust the health care needs, the annual cost is updated to reflect your estimated cost. Experiment with different scenarios to see how your plans compare.
Yes, I can customize the tool and make it available at http://pick-a-plan.appspot.com/yourcompany such that the plan information is pre-loaded needed for your company. You will also need to provide me a detailed description of the policies offered by your company so that the annual cost is more accurate. Send me a message in Twitter if you are interested.