Medical Benefits & Insurance

Medical benefits has 3 main categories:

1. Health Care Plans
2. Insurance
3. Flexible/Health Spending Accounts

Insurance Terms

• Premium: The dollar amount you pay for your health insurance or plan. You and/or your employer usually pay it monthly.
• Deductible: The amount you must pay each plan year before your plan begins to pay for covered care.
• Copay: A fixed dollar amount that you pay for certain covered services.

How does a Medical Plan work?

You pay out of pocket for your medical care until your expenses total the amount of your deductible, not including, copay. For example, my plan has a $1,000 deductible and I’ve spent $400 for my covered medical expenses. I still have to spend $600 more in medical fees to meet my deductible.

You pay a percentage (coinsurance) of some medical costs and/or a flat fee (copay) for others. For example, I visit the doctor after meeting my deductible and my plan has a $20 office visit copay & 20% coinsurance. This means I’ll pay a fixed $20 fee (my copay) for my appointment. If I was to get a blood test or some other service, I would have to pay 20% of that cost (your coinsurance).

Most plans have a total maximum out-of-pocket. This maximum is the most you could pay for covered, in-network care in a plan year, after that your plan pays 100%. Your deductible, coinsurance and copays all go toward meeting this maximum. For example, my plan has a $2,000 out of pocket max. Since I’ve hit that max my plan will pay 100% of my covered in-network services for the rest of the year. However, I would still need to pay my monthly premium.