Insurance
Your Benefits Explained
Deductibles, Co-Insurance and Copay
Once you understand the different parts of your health insurance costs you’ll want to know how these work together and what your out-of-pocket costs may be. Here are a few examples of how deductibles, coinsurance and maximum limits work together.
Understanding How Your Benefits Work
Situation One: Deductible, Co-Insurance, and Out of Pocket
For mental health coverage your insurance plan that has:
$3,000 deductible
10% coinsurance
Out-of-pocket maximum of $6,000
This means:
You must pay the first $3,000 of your medical costs.
After that, your plan covers 90% of the costs, and you pay the other 10%.
When the amount of coinsurance you’ve paid reaches $3,000, you will have paid $6,000 and at that point the plan covers 100% until your “plan year” ends. A plan is good for one year.
At the start of each year, your deductible and coinsurance resets for the next plan year and the $3,000 deductible and 10% coinsurance will start again.
$3,000 deductible
10% coinsurance
Out-of-pocket maximum of $6,000
This means:
You must pay the first $3,000 of your medical costs.
After that, your plan covers 90% of the costs, and you pay the other 10%.
When the amount of coinsurance you’ve paid reaches $3,000, you will have paid $6,000 and at that point the plan covers 100% until your “plan year” ends. A plan is good for one year.
At the start of each year, your deductible and coinsurance resets for the next plan year and the $3,000 deductible and 10% coinsurance will start again.
Situation Two: Co-Pay
Your insurance plan mental health coverage is:
Co-pay is $40.00
No deductible
Out-of-pocket maximum of $2000
This means:
You pay $40.00 for each session.
When you have paid a total of $2000 for all health care services, not just your mental health sessions, at that point the plan covers 100% until your “plan year” ends. A plan is good for one year.
At the start of each year, if you reached your out-of-pocket maximum, our plan resets for the next plan year and your $40.00 copay will start again.
Co-pay is $40.00
No deductible
Out-of-pocket maximum of $2000
This means:
You pay $40.00 for each session.
When you have paid a total of $2000 for all health care services, not just your mental health sessions, at that point the plan covers 100% until your “plan year” ends. A plan is good for one year.
At the start of each year, if you reached your out-of-pocket maximum, our plan resets for the next plan year and your $40.00 copay will start again.
