When comparing health plans, one of the main challenges is understanding the terminology. To shop smart, get familiar with the basic terms used with health insurance.

Premium: A monthly rate you pay. Premiums vary by plan and your age. Most health insurance companies renew and adjust their rates annually.

Deductible: The amount you pay for medical services before the plan begins to pay.

  • A high deductible means a lower monthly premium, but you’ll pay more out-of-pocket before the plan pays for covered services.
  • A lower deductible means a higher monthly premium, but the plan pays sooner for covered services.

Copayment (copay): A dollar amount you pay at the time you receive a service. If a plan lists a $20 copay for a doctor office visit, you pay $20 and the plan pays the rest.

Coinsurance: A percentage you pay, usually billed after a service. If a plan lists a 20% coinsurance for a lab service that costs $125, you would pay $25 (20% of $125).

Out-of-Pocket Maximum: To protect you from catastrophic costs, an out-of-pocket maximum is the total amount you pay for services (after deductible) in a calendar year.

In-Plan vs. Out-of-Plan: Using a plan’s provider network (participating/preferred provider) for services is referred to as In-Plan, and is often less expensive for members. Most plans also allow you to see any provider you choose, called Out-of-Plan with benefits at a higher coinsurance or deductible.

Exclusions and limitations: There are certain services that plans do not cover or limit coverage. Once enrolled, you will receive a contract listing all plan exclusions and limitations or you can usually call the health plan’s sales department if you have a specific question. Providence Individual Sales Team.

Interact with us
Check rates »

Why is “deductible waived” on a service important?

It’s like a free pass from your deductible to use a service. Whether you have a $1,000 or $10,000 deductible, if a service is “deductible waived” or “not subject to deductible,” you don’t need to pay first.

Top 10 reasons to choose Providence