These provisions are meant to help control the cost of the policy. For example, the higher the coinsurance percentage the carrier is required to pay, the higher your policy premium will be. Similarly, the lower your deductible and out of pocket maximum, the more you are asking the insurance company to pay, and the higher your policy premium. The more of your medical expenses you can afford to pay out of your own funds, the lower your medical insurance premium can be.

A deductible is the initial dollar amount you must pay out-of-pocket before an insurance company pays its share. It is usually a flat dollar amount. Usually the higher the deductible, the lower the premium. Coinsurance is the share or percentage of covered expenses you must pay in addition to the deductible. For example, your policy may pay 80% of covered charges after you pay the deductible. You would then pay the remaining 20% as coinsurance until a maximum out-of-pocket expense is reached. See similar questions...

The annual coinsurance maximum is the maximum amount of coinsurance payments a member is required to make in connection with covered services or supplies in a contract year. The deductible, copayments, and amounts a member may have to pay in excess of contract benefit limits and benefit exclusions do not contribute to the annual coinsurance limit. Out-of-network deductible, copayments and coinsurance are not applied to in-network annual coinsurance limit. See similar questions...

Answer: Coinsurance is the sharing of expenses between the plan and the member. Kansas Choice and Coventry PPO programs have separate coinsurance provisions for claims received from network and non network providers. As claims are processed by the plan, the member's share of coinsurance is accumulated based on the network status of the provider. See similar questions...

Coinsurance is a cost-sharing requirement where you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your deductible is met. For a health insurance plan with 20% coinsurance, once the deductible is met, the insurance company will pay 80% of the covered expenses while you pay the remaining 20% until your out-of-pocket limit is reached for the year. See similar questions...

A plan may specify an out-of-pocket amount. Once the out-of-pocket maximum is met for the calendar year, the member is no longer responsible to pay coinsurance. See similar questions...

Coinsurance is figured on all property policies and is designed to protect both the insurance company and the insured. It can be a penalty that is applied to a loss because the insured has not carried the proper amount of coverage on either the building or on personal property according to the policy terms. If coverage is written on Replacement Cost basis of 80% coinsurance, the insured is receiving a reduced rate for the coverage. See similar questions...