To make the most out of your benefit plan, it is important to understand how your plan works. Here is an overview of important health insurance terminology and how they impact your navigation of the health plan throughout the year.

• Deductible: This is the amount you are required to pay out-of-pocket for services prior to the plan covering any portion of the covered amount. These reset on an annual basis.
  
  Example: A $1,000 deductible means that an individual would pay the first $1,000 of covered medical expenses throughout the plan year.
  
  
• Coinsurance: Once the deductible is met, this is the percentage of a covered medical expense that the plan will begin to pay for until the plan out-of-pocket maximum is reached.
  
  Example: 90% coinsurance means that once the deductible is met, the plan would pay for 90% of the covered medical expense, and the member would be responsible for the remaining 10%.
  
  
• Out-of-pocket maximum: This is the most an individual must pay for medical expenses throughout the plan year. Deductibles, copays, and coinsurance all accumulate to the out-of-pocket maximum. Once this dollar amount is met, the plan will cover all remaining covered expenses at 100%.
  
  Example: The $4,000 out-of-pocket maximum signifies that the most an individual will pay for covered expenses (whether it is through deductibles, copays, or coinsurance) during the entire plan year is $4,000. After this, the plan will pay 100% for any future expenses that are covered by the plan.
  
  
• Copays: This is a fixed amount an individual will pay for a specific healthcare service or prescription. Copays do not accumulate towards the deductible. However, they accumulate towards the annual out-of-pocket maximum.
  
  
• In-Network vs. Out-of-Network: When a provider is "In-Network," this means that they have a contract directly with the insurance carrier, so the level of coverage for that service will be greater. In-network benefits allow for a higher level of coverage, meaning lower out-of-pocket costs to the member once a claim is filed.
  
  Helpful tip: Prior to receiving services, consult the insurance carrier's provider directory to verify network status or speak with the provider directly. If you are consulting with the provider, ask if they are contracted with the insurance carrier. This distinction is very important, as all providers will say they accept insurance. The provider may accept insurance; however, if they are not contracted, there will be no in-network coverage.