Coinsurance

From SmartMedicalConsumer Wiki

The portion of covered health care costs for which the insured person has a financial responsibility, usually according to a fixed percentage. For example, if your plan is an 80/20 plan, then coinsurance means the plan pays 80% of your covered costs and you are responsible for paying the remaining 20% after you meet the deductible. The 20% you pay is called Coinsurance. Coinsurance amounts apply to your out-of-pocket maximum for the calendar year.

Note that in the above example, the health plan covers 80% of the allowable amount (covered portion) of a service. Thus, if your provider bills you for more than the allowed amount, you may also need to pay the difference between what provider charges and what insurance allows.

For example, your doctor bills you for $200; you already reached your deductible maximum; and your insurance allows only $100 out of $200. The insurance will pay 80% of $100. You will pay 20% of $100, and if this provider is not a participating provider or an in-network provider, you will also pay the remaining $100 which is not covered by insurance.

[edit] Coinsurance Maximum

The maximum annual amount an employee is responsible to pay, after deductibles, before their plan pays all further expenses at 100% during the calendar year.