Based on the plan you choose, you may have to pay different amounts when visiting a doctor or nurse. When you pay for care, the charges are called “out-of-pocket expenses”. These include –
Copayments (or Copays) – A fixed amount you pay for a covered health care service, usually when you receive the service.
Deductible – The amount you owe for health care services before your insurance plan begins to pay. For example, if your deductible is $1000, insurance won’t pay anything until you’ve met your $1000 for covered health care services subject to the deductible. The deductible may not apply to all services.
Coinsurance – Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if your plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. Your insurance pays the rest of the allowed amount.
Maximum Out-of-Pocket – The most you will pay in calendar year for covered services. This does not include your monthly premium.
In addition to your out-of-pocket expenses, you also pay a monthly fee for your health insurance. This is called your premium.
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Quartz Health Solutions, Inc., Unity Health Plans Insurance Corporation, Gundersen Health Plan, Inc., Gundersen Health Plan Minnesota, Physicians Plus Insurance Corporation, Gundersen Health System, UnityPoint Health and UW Health are separate legal entities. Plans are underwritten by Unity Health Plans Insurance Corporation unless otherwise noted.