How are Deductibles, Co-insurance, and Co-pays calculated?
Deductibles, co-insurance and co-pays are calculated based on your benefit design (your health insurance policy) and for covered services the negotiated price that the insurance company and the health care provider agree the health care provider will be reimbursed for services. These amounts can vary considerably among different types of insurance policies and different carriers. The deductible will be paid first, followed by co-insurance. Co-pays are handled separately from the deductible and the co-insurance, and apply to specified services each time that service is purchased. If for example you have a $15 co-pay for pharmacy but you have a $100 deductible as well, you would pay the entire cost of the prescription until you have spent $100 and then you would be charged the $15 co-pay. Both deductibles and co-pays, however, are applied to out-of-pocket maximum (see below).
