Deductible

The deductible is the amount of coverage expenses you pay each calendar year before benefits are paid under the policy.

 Coinsurance

The coinsurance is the insurance plan’s level of coverage after the calendar year deductible is satisfied. After the coinsurance maximum is met, the insurer pays 100% of covered expenses for the remainder of the calendar year.

 Out-of-Pocket Maximum

The out-of-pocket maximum is a specific limit on the amount of covered expenses you pay per calendar year. When an individual out-of-pocket maximum level has been reached, the individual no longer pays deductible or coinsurance for the remainder of that calendar year. Out-of-pocket expenses for all family members contribute to meeting the family out-of-pocket maximum. Once the family out-of-pocket maximum has been met, none of the family members pay deductible or coinsurance for the remainder of that calendar year.

 Non-network deductibles and coinsurance amounts credit toward both the network and non-network out-of-pocket maximums. The network deductible and coinsurance apply only to the network out-of-pocket maximum.