by Colleen Posey

Understanding Health Insurance Terminology


The majority, if not most, of our population is covered by a health insurance policy. Whether you have an individual health policy or coverage through your employer, we are all required to have health insurance. Having insurance isn’t as simple as just being covered whenever you seek medical attention. It is very important to understand the design of your insurance policy to know what your out of pocket expenses are going to be. Health insurance policies have terminology such as deductible, coinsurance, and out-of-pocket maximums that many people think of as a foreign language. In my post today I’m hoping to clear some things up that I know confused me before I became fully immersed in the health insurance world. Most of us know that a deductible is a specified amount of money that an individual is required to pay before the insurance will pay towards a claim. Once the deductible amount is met, the cost sharing begins to take place with the insurance company through coinsurance. Now you are probably asking, what in the world is coinsurance?! Coinsurance is when the insurance company will pay a percentage of a claim leaving the remaining percentage as the individual’s responsibility. An example of a common coinsurance percentage is the insurance company paying 80% and the individual paying 20% of a particular service. This coinsurance cost sharing percentage is paid on claims until the out-of-pocket maximum/limit is reached. The money that is put toward deductible, copays, and coinsurance all go toward your out-of-pocket maximum. Your out-of-pocket maximum will be the most you pay for your medical expenses. Once this is reached, insurance pays at 100%. Also, always be sure to check on services to ensure that they are considered a covered benefit under your policy. If you have an individual policy or an employer sponsored policy through VAST please feel free to reach out to us with any questions or concerns on your policy.

Our foundation may be insurance, but we have evolved, and so have the solutions that we provide.